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Clinical calculator summary

Khorana VTE Risk Score

The original pretreatment score using cancer site and blood-count/body-size factors to estimate early chemotherapy-associated VTE risk.

Evidence-based context for fast calculator use

Purpose:
Support ambulatory cancer-associated thrombosis risk assessment before a new chemotherapy regimen
Population:
Ambulatory adults with cancer before starting a new chemotherapy regimen
Factors:
Original cancer-site category, Pretreatment platelets, Hemoglobin or ESA use, Pretreatment leukocytes, BMI
Reference:
Khorana et al., Blood. 2008
HomeKhorana Score (VTE Risk)
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Khorana Score (VTE Risk)

×10⁹/L

One point at 350 ×10⁹/L or higher.

g/dL

One point below 10 g/dL, or when ESA use is present.

Shares one score point with hemoglobin below 10 g/dL; the pair is not double-counted.

×10⁹/L

One point above 11 ×10⁹/L.

kg/m²

One point at 35 kg/m² or higher.

Clinical Context & Background

This calculator implements the original 2008 Khorana score for ambulatory adults before a new chemotherapy regimen. It uses pretreatment tumor site, platelet count, hemoglobin or ESA use, leukocyte count, and BMI.
The original risk groups are score 0 low, 1-2 intermediate, and 3-6 high. Contemporary ambulatory thromboprophylaxis guidance often uses score 2 or more as a threshold to consider a separate eligibility assessment; that policy threshold does not redefine the original score group and does not automatically authorize anticoagulation.
This is the original model, not the modified AVERT site scoring. Brain, kidney, and myeloma populations require model- and disease-specific review, and myeloma treated with immunomodulatory drugs requires a dedicated thromboprophylaxis pathway.
Primary Source EvidenceKhorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Blood. 2008;111(10):4902-4907.
Formula Logic
Original score = site points (0, 1, or 2) + platelets ≥350 (1) + hemoglobin <10 or ESA use (1 total) + leukocytes >11 (1) + BMI ≥35 (1).

Reference Data

Original groupScoreOriginal derivation / validation VTE incidence
Low Risk00.8% / 0.3%
Intermediate Risk1-21.8% / 2.0%
High Risk3-67.1% / 6.7%

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use before a new outpatient chemotherapy regimen when considering VTE risk and a separate thromboprophylaxis eligibility assessment.
  • Use only when the patient and clinical setting match the population described for Khorana VTE Risk Score.

How To Interpret

  • Original score groups are 0 low, 1-2 intermediate, and 3-6 high; the guideline consideration threshold of 2 does not redefine those groups.
  • Interpret thresholds with the entered units, current clinical status, and local guideline context.

What To Do Next

  • Balance VTE risk against bleeding risk, interactions, renal/hepatic function, platelet trend, procedures, patient preference, and current thromboprophylaxis guidance.
  • Document the inputs, result, clinical judgment, and any reason for deviating from the model-guided pathway.

Limitations

  • Do not diagnose VTE, automatically prescribe anticoagulation, or apply this model to hospitalized, perioperative, pediatric, or myeloma-specific prophylaxis settings.
  • This calculator supports clinical assessment and does not independently prescribe treatment.

Validated Population

Ambulatory adults with cancer before starting a new chemotherapy regimen

Clinical example

A score of 2 remains intermediate in the original model but may trigger a separate guideline-based prophylaxis eligibility discussion.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed Khorana cases passed through visible production controls at scores 0, 2, and 6.
    • No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/khorana-vte-risk-score-2026-08-03.json.

  2. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/khorana-vte-risk-score.json.

  3. : Input workflow simplified and revalidated

    • Reduced the public form to result-, branch-, unit-, and applicability-changing inputs; removed or consolidated non-scoring, administrative, and duplicate questions.
    • Preserved the verified calculation or report-interpretation logic, thresholds, model version, component logic, and supported result pathways behind strict deterministic adapters.
    • Passed the calculator-specific regression audit, adapter-parity and malformed-input checks, the 144-calculator input-quality audit, and the 43-calculator entry-burden audit.

  4. : Full validation test

    • Passed 88/88 exhaustive score-matrix, raw-threshold, population, missing-input, extra-input, and malformed-input checks.
    • Confirmed the original 0-6 score, score 0 / 1-2 / 3-6 groups, and exact platelet, hemoglobin/ESA, leukocyte, and BMI boundaries.

  5. : Correction

    • Replaced favorable point-coded defaults with required raw pretreatment age, setting, chemotherapy context, VTE status, cancer site, CBC, ESA, and BMI inputs.
    • Added a strict ten-field input contract and rejected extra, missing, malformed, negative, and nonfinite values.
    • Replaced contradictory unsourced VTE-rate ranges with the original derivation and validation cohort incidences and follow-up context.
    • Separated the original high-risk cutoff at 3 from the contemporary score-2 prophylaxis-assessment threshold and removed any implication of automatic anticoagulant prescribing.

    Included in the current validation report.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

What is Khorana VTE Risk Score used for?

Support ambulatory cancer-associated thrombosis risk assessment before a new chemotherapy regimen. It is intended for ambulatory adults with cancer before starting a new chemotherapy regimen.

Does Khorana VTE Risk Score determine treatment by itself?

No. Confirm the population, inputs, contraindications, competing risks, and current guideline recommendations before acting on the result.

Evidence-based oncology decision support. Verify with clinical guidelines.