Critical Care Medicine-Hematologic and Oncologic Disorders>>>>>Hypercoagulable States
Question 3#

A 58-year-old obese man with pancreatic cancer recently started neoadjuvant chemotherapy before a planned surgical resection. He presents to the emergency department with shortness of breath and chest pain. His hemoglobin is 11.5 g/dL, platelets are 550 × 10 9 /L, and white blood cell count is 10.5 × 10 9 /L. 

He is hemodynamically stable. He had noticed swelling of his left lower extremity a week prior. He denies family history of “clots.” Computed tomography (CT) angiogram revealed pulmonary embolism, and therapeutic anticoagulation is initiated.

Which of the following is a component of the Khorana score that has been validated as a risk factor for the development of venous thromboembolism (VTE) in a patient receiving chemotherapy?

A. Age >55
B. Body mass index (BMI) >30
C. Prechemotherapy platelet count >350 × 109 /L
D. Thyroid cancer

Correct Answer is C


Correct Answer: C

Cancer induces a hypercoagulable state that puts patients at risk for thrombotic complications. Up to 10% of patients with cancer may develop VTE. Certain tumor types are associated with higher risk: for example, 30% to 50% of patients with pancreatic cancer have evidence of thrombosis.

The Khorana risk score for VTE in cancer patients is a validated scoring tool intended to be used in patients undergoing chemotherapy to stratify patients in terms of their future risk of VTE. The tool can be used to identify patients who are high risk and select those patients for ultrasound screening to diagnose DVT early. Data regarding use of the score for selecting patients for thromboprophylaxis are pending.

Components of the score are:

  1. Cancer type (stomach, and pancreas get two points, lung, lymphoma, gynecologic, bladder, and testicular cancers get one point)
  2. Prechemotherapy platelet count of ≥350 × 109/L, hemoglobin level <10 g/dL
  3. prechemotherapy leukocyte count >11 × 109/L
  4. BMI ≥35 kg/m2

A score of ≥3 infers a 6.7% to 7.1% risk of VTE in 2.5 months. 


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