{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:04:53Z","timestamp":1792508693099,"version":"4.5.0"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Venous thromboembolism (VTE) is associated with increased mortality and morbidity in patients with cancer. Existing risk prediction models are typically validated within individual sites, a fragmented approach that limits clinical adoption.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To validate the electronic health record cancer-associated thrombosis (EHR-CAT) score compared with the benchmark Khorana score in a contemporary cohort of patients with cancer across the nation, before and after treatment, excluding those at high risk of bleeding.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This prognostic study included patients in a nationwide longitudinal EHR database from January 2018 to December 2023 with follow-up continuing to April 2025. Patients with newly diagnosed, invasive, solid, or hematologic malignant neoplasms (defined using validated\n International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM]<\/jats:italic>\n algorithms) receiving systemic therapy (defined using the first antineoplastic medication) were included. Those with recent history of acute VTE diagnosis or anticoagulant prescription were excluded.\n <\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Demographics, risk model variables, and common anticoagulant trial exclusion criteria (as a proxy for identifying people at high risk of bleeding) were extracted on or before index therapy initiation date.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes<\/jats:title>\n \n Incident VTE and bleeding outcomes at 6 months were defined using validated\n ICD-10-CM<\/jats:italic>\n algorithms.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 732\u202f594 patients (median [IQR] age, 65.0 [56.9-73.0] years; 425\u202f124 female [58.0%]; 25\u202f634 Asian [3.5%], 94\u202f269 Black [12.9%], 48\u202f266 Hispanic [6.6%], 583\u202f047 White [76.9%]) with active cancer receiving systemic therapy between 2018 and 2023 from 184 health systems were identified. With a median (IQR) follow-up of 676 (340-1151) days, the incidence of 6-month VTE, bleeding, and mortality was 4.7% (34\u202f499 patients), 3.7% (26\u202f993 patients), and 8.4% (60\u202f239 patients), respectively. Bleeding risk was higher in the 26.0% of patients (190\u202f413) meeting anticoagulant trial exclusion criteria (7.2% vs 2.4%; hazard ratio, 2.5 [95% CI, 2.5-2.5]). The EHR-CAT score stratified patients into discriminative risk groups (C statistic, 0.70-0.71) both before and after exclusion for bleeding risk. When compared with the benchmark Khorana score (C statistic, 0.63), EHR-CAT reclassified 20% of patients into revised categories with improved prediction accuracy. Furthermore, EHR-CAT had consistent calibration in subgroups by age, sex, race, ethnicity, and individual health system sites.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This prognostic study of the EHR-CAT risk score demonstrated the external validity and feasibility of using readily available structured EHR data to estimate VTE risk in patients with cancer.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.44428","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:00:17Z","timestamp":1764086417000},"page":"e2544428","source":"Crossref","is-referenced-by-count":7,"title":["Validation of a Risk Score for Cancer-Associated Thrombosis Using Nationwide EHR Data"],"prefix":"10.1001","volume":"8","author":[{"given":"Ang","family":"Li","sequence":"first","affiliation":[{"name":"Section of Hematology-Oncology, Baylor College of Medicine, Houston, 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