Assessing the Risk of Venous Thromboembolism in Patients with
Hematological Cancers using Three Prediction Models
Abstract
Background: Assessment of individual VTE risk in cancer
patients prior to chemotherapy is important. Risk assessment models
(RAM) are available but have not been validated for hematological
malignancy. We aimed to assess validity of the Vienna Cancer and
Thrombosis Study (CATS) score in prediction of VTE in a variety of
hematological malignancies. Methods: This is a prospective
cohort study conducted on 81 newly diagnosed cancer patients undergoing
chemotherapy. Demographic, clinical and cancer related data were
collected and patients were followed up for 6 months for VTE events.
Khorana score (KS) was calculated. Plasma D-dimer and sP-selectin were
measured then V-CATS score was calculated. We assessed modified V-CATS
by using new cut off levels of d-dimer and sP-selectin based on ROC
curve of the patients’ results. Results: Out of the 81 patients
assessed, 2.7% had advanced cancer with metastasis. The most frequent
cancer was Non-Hodgkin lymphoma (39.5%) and 8 patients (9.8%)
developed VTE events. The calculated probability of VTE occurrence using
KS, V-CATS and modified V-CATS scores at cut off levels ≥3 were 87.5%,
87.5%, 100% respectively. The AUC in ROC curve of modified Vienna CATS
score showed significant difference when compared to that of V-CATS and
KS (P= 0.047 and 0.029, respectively). Conclusion: Our data
shows the usefulness of three VTE risk assessment models in
hematological malignancies. Modified V-CATS score is more specific
compared with V-CATS and KS, while all three scores have similar
sensitivity. Implementation of RAM in hematological cancers can help
improve the use of thromboprophylaxis.