Highlights
- •Khorana score has been shown to predict venous thromboembolism in cancer patients.
- •We aimed to test this score to predict recurrent thromboembolism (RTE) in cancer patients with ischemic stroke.
- •Khorana score was weakly associated with RTE in cancer patients with ischemic stroke, and did not accurately predict RTE.
- •Addition of other parameters such as D-dimer appears to improve the predictive accuracy of the score.
Abstract
Cancer patients with acute ischemic stroke (AIS) are high-risk for recurrent thromboembolic
events (RTE). Currently, no risk stratification model exists to predict RTE in this
population. We tested the hypothesis that the Khorana score, a validated risk model
for predicting venous thromboembolism in cancer patients, can effectively classify
RTE risk in cancer patients with AIS. We retrospectively identified adults with active
solid or hematological cancer diagnosed with AIS at a tertiary-care cancer center
from 2005 to 2010. The Khorana score at the time of index stroke was calculated. The
primary outcome was arterial or venous RTE. Cox regression was used to evaluate the
association of the Khorana score and its individual components with RTE. Harrell’s
c-statistic was used to calculate the score’s discriminatory ability. Among 263 AIS
patients, median survival was 84 days (IQR 24–149 days) and 90 (34%) had RTE. The
median Khorana score was 2 (IQR 1–2, range 0–5). Cumulative rate of RTE was 28% among
patients who scored 0, 36% with scores of 1–2, and 32% with scores of 3–6. The overall
Khorana score was marginally associated with RTE (HR, 1.14; 95% CI, 1.02–1.28). Of
its individual components, only leukocytosis was associated with RTE (HR adjusted
for other components, 1.45; 95% CI 1.11–1.90). The score’s c-statistic for predicting
RTE was 0.57. In this study, the Khorana score had poor discriminatory ability for
predicting RTE in cancer patients with AIS. Future research is needed to identify
better methods for predicting RTE in this high-risk population.
Keywords
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Article info
Publication history
Published online: August 22, 2018
Accepted:
August 12,
2018
Received:
February 1,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
