The following article features coverage from the American Society of Hematology 2019 Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

A new scoring method based on the presence of elevated biomarkers may provide a more nuanced risk stratification of venous thromboembolism (VTE) than present methods. The results of a study assessing the scoring technique was presented at the 61st American Society of Hematology (ASH) Annual Meeting & Exposition, held in Orlando, Florida.

The study was an extension of the larger AVERT trial which compared the drug apixaban to a placebo for the prevention of VTE in 466 ambulatory cancer patients. Typically, VTE risk is measured using a Khorana score, which takes into account available clinical data including the type of cancer, the complete blood count, and the patient’s body mass index. Risk is ranked as 0 for low, 1 to 2 for intermediate, and 3 to 6 for high. In contrast, the relatively new CATS scoring method accounts for the presence of elevated VTE biomarkers.


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In the present study, patients were randomly tested for the d-dimer and/or p-selectin VTE biomarkers. If either biomarker was detected over the 75th percentile, the patient was given 1 additional point per elevated measurement. Khorana scores were 3 or higher for 31.9% of patients in the placebo group and 36.3% of patients in the apixaban group; CATS scores were 4 or higher for 22.7% of the placebo group and 27.9% of the apixaban group. VTE incidence at 6 months was 13% in patients with Khorana scores of 3 or higher and 20% in patients with CATS scores of 4 or higher.

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However, a significant linear trend for association of CATS risk score with VTE was observed, suggesting potential for further stratification. No such significant trend was noted between Khorana risk score and VTE risk. “Incorporation of d-dimer and p-selectin enhances VTE risk stratification in ambulatory cancer patients with a Khorana score of [2 or greater],” concluded the study authors.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Shaw JR, Mallick R, Carrier M, Ilich A, Key NS, Wells PS. Enhanced VTE risk stratification in ambulatory patients with cancer. Oral presentation at: 61st ASH Annual Meeting & Exposition; December 7-10, 2019; Orlando, FL. Abstract 634.