PB0920 - Performance of the Thrombogyn and Khorana scores for prediction of venous thromboembolism in ovarian cancer patients after major surgery

Background: Guidelines recommend extended thromboprophylaxis for prevention of venous thromboembolism (VTE) in ovarian cancer patients undergoing major surgery. Individual VTE risk, however, may vary widely. The Thrombogyn and Khorana scores may be helpful in identifying low-risk patients for whom shorter duration thromboprophylaxis could be beneficial.

Aims: To evaluate the predictive performance of the Thrombogyn and Khorana scores for VTE in ovarian cancer patients after major surgery.

Methods: A retrospective cohort study was performed in women with ovarian cancer who underwent major surgery between January 2017 and December 2020. Those with ongoing therapeutic anticoagulation or recent minor surgery were excluded. The primary outcome was pulmonary embolism, deep-vein thrombosis, and cerebral vein thrombosis during 90-day follow-up. Discriminatory performance of continuous scores was evaluated by the area under the receiver operating curve (AUROC) and dichotomous scores by the cumulative VTE incidence in high- and low-risk groups with corresponding hazard ratio (HR). Subgroup analyses were performed in patients receiving standard ( < 10 days) and extended thromboprophylaxis (>26 days).

Results: 253 women were included (see Table for baseline characteristics). Scores could be calculated for 245 (97%) patients, of whom 18 developed VTE (7.5%, 95%CI: 4.6-11.3%) during 90-day follow-up. The AUROC at 90 days for the continuous Thrombogyn and Khorana scores were 0.50 (95%CI: 0.39-0.61) and 0.57 (95%CI: 0.44-0.70), respectively. Thrombogyn score ≥2 and Khorana score ≥3 were not significantly associated with VTE risk (HR 0.7, 95%CI: 0.4-1.9 and 2.3, 95% 0.5-7.0, respectively; Figure). Analyses in 119 (49%) patients with standard and 100 (41%) with extended prophylaxis showed similar results.

Conclusion(s): The Thrombogyn did not discriminate between ovarian cancer patients at high and low VTE risk after major surgery. The Khorana score showed better discrimination, although not significant. These results do not support their use in guiding the duration of thromboprophylaxis in this setting.