First, I want to thank the authors, faculty, and residents for agreeing to participate in this interactive discussion! Currently, guidelines do not recommend thromboprophylaxis in patients with active malignancy as previous trials did not show a substantial absolute risk reduction indicating benefit. The AVERT and CASSINI trials were randomized, blinded, placebo-controlled multicenter trials evaluating the use of apixaban and rivaroxaban respectively for thromboprophylaxis in high-risk ambulatory patients with cancer, as defined by a Khorana score of greater than or equal to 2. The AVERT trial found a significantly lower rate of venous thromboembolism compared to placebo with an absolute risk reduction (ARR) of 6%, corresponding to a NNT of 17. Conversely, the CASSINI trial did not show a significantly lower incidence of VTE or death in the 180-day trial period but did show a 3.8% ARR during the intervention-period analysis.
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