Cochrane · systematic review · CD006466
Oral anticoagulation in people with cancer who have no therapeutic or prophylactic indication for anticoagulation
Kahale, LA, Matar, CF, Tsolakian, IG, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
11
No studies
3
Included studies
NR
No studies 3 · 21.4%Ungraded 0 · 0%Very low 2 · 14.3%Low 1 · 7.1%Moderate 8 · 57.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyVitamin K antagonist (VKA) prophylaxis compared to no prophylaxis in ambulatory people with cancer without venous thromboembolism (VTE) receiving systemic therapy
Population: ambulatory people with cancer without venous thromboembolism receiving systemic therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome: Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | no estimate extracted | NR | No studies |
Mortality at 6 months: main analysis Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | RR 0.93 [0.77, 1.13] | 3 studies · 946 participants | Moderate Downgraded: risk of bias, imprecision |
Mortality Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | RR 0.95 [0.87, 1.03] | 5 studies · 1281 participants | Moderate Downgraded: risk of bias, imprecision |
Pulmonary embolism Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | RR 1.05 [0.07, 16.58] | 1 study · 311 participants | Very low Downgraded: imprecision, indirectness |
Symptomatic deep vein thrombosis Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | RR 0.08 [0.01, 1.42] | 1 study · 311 participants | Very low Downgraded: imprecision, indirectness |
Major bleeding Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | RR 2.93 [1.86, 4.62] | 5 studies · 1281 participants | Moderate Downgraded: risk of bias |
Minor bleeding Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | RR 3.14 [1.85, 5.32] | 4 studies · 863 participants | Moderate Downgraded: risk of bias |
Quality of life ‐ not reported Vitamin K antagonist (VKA) prophylaxis vs no prophylaxis | no estimate extracted | NR | No studies |
Direct oral anticoagulant (DOAC) prophylaxis compared to no prophylaxis in ambulatory people with cancer without venous thromboembolism (VTE) receiving systemic therapy
Population: ambulatory people with cancer without venous thromboembolism receiving systemic therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome: Direct oral anticoagulant (DOAC) prophylaxis vs no prophylaxis | no estimate extracted | NR | No studies |
Mortality Direct oral anticoagulant (DOAC) prophylaxis vs no prophylaxis | RR 0.94 [0.64, 1.38] | 3 studies · 1440 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Pulmonary embolism Direct oral anticoagulant (DOAC) prophylaxis vs no prophylaxis | RR 0.48 [0.24, 0.98] | 3 studies · 1440 participants | Moderate Downgraded: risk of bias, imprecision |
Symptomatic deep vein thrombosis Direct oral anticoagulant (DOAC) prophylaxis vs no prophylaxis | RR 0.61 [0.31, 1.21] | 3 studies · 1440 participants | Moderate Downgraded: risk of bias, imprecision |
Major bleeding Direct oral anticoagulant (DOAC) prophylaxis vs no prophylaxis | RR 1.65 [0.72, 3.8] | 3 studies · 1440 participants | Moderate Downgraded: risk of bias, imprecision |
Minor bleeding Direct oral anticoagulant (DOAC) prophylaxis vs no prophylaxis | RR 3.58 [0.55, 23.44] | 3 studies · 1440 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
VKA prophylaxis compared to No prophylaxis in ambulatory patients with cancer without VTE receiving systemic therapy
Population: ambulatory people with cancer without VTE receiving systemic therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality VKA prophylaxis vs No prophylaxis | RR 0.95 [0.87, 1.03] | 5 studies · 1281 participants | Moderate Downgraded: risk of bias, imprecision |
PE VKA prophylaxis vs No prophylaxis | RR 1.05 [0.07, 16.58] | 1 study · 311 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Symptomatic DVT VKA prophylaxis vs No prophylaxis | RR 0.08 [0, 1.42] | 1 study · 311 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Major bleeding VKA prophylaxis vs No prophylaxis | RR 2.93 [1.86, 4.62] | 5 studies · 1281 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Minor bleeding VKA prophylaxis vs No prophylaxis | RR 3.14 [1.85, 5.32] | 4 studies · 863 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
HRQoL ‐ not reported VKA prophylaxis vs No prophylaxis | no estimate extracted | NR | No studies |
DOAC prophylaxis compared to No prophylaxis in ambulatory patients with cancer without VTE receiving systemic therapy (Q6b‐ Oral)
Population: ambulatory people with cancer without VTE receiving systemic therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality DOAC prophylaxis vs No prophylaxis | RR 0.24 [0.02, 2.56] | 1 study · 92 participants | Low Downgraded: risk of bias |
PE DOAC prophylaxis vs No prophylaxis | RR 0.16 [0.01, 3.91] | 1 study · 92 participants | Low Downgraded: risk of bias |
Symptomatic DVT DOAC prophylaxis vs No prophylaxis | RR 0.07 [0, 1.32] | 1 study · 92 participants | Low Downgraded: risk of bias |
Major bleeding DOAC prophylaxis vs No prophylaxis | RR 0.16 [0.01, 3.91] | 1 study · 92 participants | Low Downgraded: risk of bias |
Minor bleeding DOAC prophylaxis vs No prophylaxis | RR 4.43 [0.25, 79.68] | 1 study · 92 participants | Low Downgraded: risk of bias |
HRQoL ‐ not reported DOAC prophylaxis vs No prophylaxis | no estimate extracted | NR | No studies |
Oral anticoagulation in patients with cancer with no therapeutic or prophylactic indication for anticoagulation
Population: patients with cancer with no therapeutic or prophylactic indication for anticoagulation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality | RR 0.97 [0.89, 1.04] | 6 studies · 1539 participants | Moderate Downgraded: risk of bias, imprecision |
VTE | RR 0.15 [0.02, 1.2] | 1 study · 311 participants | Moderate |
Major bleeding | RR 4.24 [1.86, 9.65] | 4 studies · 1184 participants | Moderate Downgraded: risk of bias, imprecision |
Minor bleeding | RR 3.19 [1.83, 5.55] | 4 studies · 865 participants | Moderate Downgraded: risk of bias, imprecision |
Health‐related quality of life ‐ not reported | no estimate extracted | NR | No studies |
Oral anticoagulation in patients with cancer with no therapeutic or prophylactic indication for anticoagulation
Population: patients with cancer with no therapeutic or prophylactic indication for anticoagulation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality | RR 0.97 [0.89, 1.04] | 6 studies · 1539 participants | Moderate Downgraded: risk of bias, imprecision |
VTE | RR 0.15 [0.02, 1.2] | 1 study · 311 participants | Moderate |
Major bleeding | RR 4.24 [1.86, 9.65] | 4 studies · 1184 participants | Moderate Downgraded: risk of bias, imprecision |
Minor bleeding | RR 3.19 [1.83, 5.55] | 4 studies · 865 participants | Moderate Downgraded: risk of bias, imprecision |
Health‐related quality of life ‐ not reported | no estimate extracted | NR | No studies |
Oral anticoagulation in patients with cancer with no therapeutic or prophylactic indication for anticoagulation
Population: patients with cancer with no therapeutic or prophylactic indication for anticoagulation.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death | RR 0.94 [0.87, 1.03] | 5 studies · 1604 participants | Moderate Downgraded: risk of bias, imprecision |
VTE | RR 0.15 [0.02, 1.2] | 1 study · 315 participants | Moderate |
Major bleeding | RR 4.24 [1.85, 9.68] | 4 studies · 1282 participants | Moderate Downgraded: risk of bias, imprecision |
Minor bleeding | RR 3.34 [1.66, 6.74] | 3 studies · 851 participants | Moderate Downgraded: risk of bias, imprecision |
Health related quality of life ‐ not reported | no estimate extracted | NR | No studies |
Oral anticoagulation in patients with cancer with no therapeutic or prophylactic indication for anticoagulation
Population: patients with cancer with no therapeutic or prophylactic indication for anticoagulation.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death | RR 0.94 [0.87, 1.03] | 5 studies · 1604 participants | Moderate Downgraded: risk of bias, imprecision |
VTE | RR 0.15 [0.02, 1.2] | 1 study · 315 participants | Moderate |
Major bleeding | RR 4.24 [1.85, 9.68] | 4 studies · 1282 participants | Moderate Downgraded: risk of bias, imprecision |
Minor bleeding | RR 3.34 [1.66, 6.74] | 3 studies · 851 participants | Moderate Downgraded: risk of bias, imprecision |
Health related quality of life ‐ not reported | no estimate extracted | NR | No studies |
Comparison
Population: prolonging survival in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death ( | RR 0.94 [0.87, 1.03] | 4 studies · 1604 participants | Moderate |
Major bleeding ( | RR 4.24 [1.85, 9.68] | 4 studies · 1282 participants | High |
Minor bleeding | RR 3.34 [1.66, 6.74] | 3 studies · 851 participants | Moderate |