Derivation and validation of the Caravaggio score for the risk stratification for recurrence in patients with cancer-associated venous thromboembolism

Maria Cristina Vedovati ¹, Andrés J Muñoz Martín ², Michela Giustozzi ¹

¹Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
²Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
³Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain.
⁴Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital Universitario Basurto, Basque Country University-UPV/EHU, Bilbao Bizkaia, Spain.
⁵Internal Medicine, University of Insubria, Varese, Italy.
⁶Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
⁷Department of Haematology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, King's College London, United Kingdom.
⁸CCB-Cardioangiologic Center Bethanien, Frankfurt, Germany.
⁹Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain.

⁰Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.

European Journal of Internal Medicine +

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April 19, 2025

View abstract on PubMed

Summary

The Caravaggio score effectively identifies cancer patients at high risk of venous thromboembolism recurrence. This validated tool stratifies patients into risk groups, aiding clinical management during anticoagulation.

Area Of Science

Oncology
Hematology
Clinical Risk Stratification

Background

Cancer-associated venous thromboembolism (CAT) poses a significant clinical challenge.
Risk-based scores are crucial for managing CAT and preventing recurrence.
Existing scores may not fully capture the complexity of VTE risk in cancer patients.

Purpose Of The Study

To develop and validate the Caravaggio score for predicting recurrent venous thromboembolism (VTE) in patients with cancer.
To stratify patients with CAT into distinct risk categories for VTE recurrence.
To provide a tool for guiding clinical management and anticoagulation strategies.

Main Methods

The Caravaggio score was developed using data from the Caravaggio trial and validated in the TESEO registry.
Predictors of VTE recurrence were identified using multivariable Cox regression, accounting for competing risks (non-VTE death).
The score's performance was evaluated using discrimination (c-statistics) and predictive values (sensitivity, specificity, PPV, NPV).

Main Results

Key predictors included symptomatic VTE, specific cancer types (ovarian, uterine, pancreatic), metastatic disease, adenocarcinoma subtype, and anticancer treatment.
Recurrent VTE rates varied significantly across risk groups: High (11.6% derivation, 8.0% validation), Intermediate (7.7% derivation, 3.5% validation), and Low (2.5% derivation, 1.7% validation).
The score demonstrated moderate discrimination (c-statistics ~0.60-0.64) and a high negative predictive value (98%) for identifying low-risk patients.

Conclusions

The Caravaggio score is a simple and effective tool for stratifying cancer patients based on their risk of VTE recurrence.
This score can aid clinicians in tailoring anticoagulation management for patients with CAT.
Further research may explore the integration of the Caravaggio score into routine clinical practice.

Keywords:

Cancer Risk score Venous thromboembolism

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