Khorana et al identified risk factors for thromboembolism in a hospitalized cancer patient with neutropenia. This can help identify a patient who may benefit from closer monitoring or anticoagulation. The authors are from the University of Rochester in Rochester, New York.


The study was a retrospective cohort study of the discharge database of the University Health System Consortium from 115 medical centers in the United States.


Risk factors venous thromboembolism identified on multivariate analysis (Table 4, page 489):

(1) age of the patient in years

(2) type of cancer

(3) comorbid conditions

(4) arterial thrombosis


Cancers associated with an increased risk of venous thromboembolism:

(1) lung

(2) stomach

(3) pancreas

(4) ovary

(5) other abdominal

(6) endometrium or cervix

(7) brain

(8) lymphoma or leukemia (reported in text)


Comorbid conditions with an increased risk of venous thromboembolism:

(1) pulmonary disease

(2) renal disease

(3) infection

(4) obesity




age of the patient

< 65 years



>= 65 years


arterial thromboembolism






site of cancer

not associated with increased risk



associated with increased risk


comorbid conditions




number of risk factors =

= SUM(points for all of the risk factors)


Risk factors associated with arterial thromboembolism (results of multivariate analysis not reported, page 485):

(1) age >= 65 years of age

(2) male gender

(3) black race

(4) site of cancer (leukemia, colon, lung, prostate)

(5) comorbidities (infection, pulmonary disease, hypertension, renal disease, diabetes mellitus, congestive heart failure, hepatic disease)



• minimum number of risk factors for venous thromboembolism: 0

• maximum number of risk factors for venous thromboembolism: 7

• The prognosis for a patient with a venous or arterial thromboembolism is poor, with increased in-hospital mortality.



• The odds ratios for most of the risk factors were in the 1.12 to 1.60, which are relatively weak.


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