Cochrane · systematic review · CD006468
Anticoagulation for people with cancer and central venous catheters
Kahale, LA, Tsolakian, IG, Hakoum, MB, et al. · Cochrane Database of Systematic Reviews · 2018 · 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
24
current version
GRADE rated
21
No studies
3
Included studies
NR
No studies 3 · 12.5%Ungraded 0 · 0%Very low 7 · 29.2%Low 12 · 50%Moderate 2 · 8.3%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 onlyLow‐molecular‐weight heparin (LMWH) compared to no LMWH for people with cancer and central venous catheters
Population: people with cancer with thrombosis prophylaxis and central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes ( Low‐molecular‐weight heparin (LMWH) vs no LMWH | no estimate extracted | NR | No studies |
All‐cause mortality (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs no LMWH | RR 0.82 [0.53, 1.26] | 5 studies · 1236 participants | Low Downgraded: risk of bias |
Symptomatic catheter‐related thrombosis (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs no LMWH | RR 0.43 [0.22, 0.81] | 5 studies · 1089 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Symptomatic catheter‐related thrombosis measured as asymptomatic catheter‐related thrombosis (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs no LMWH | RR 0.95 [0.62, 1.46] | 5 studies · 1089 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Major bleeding (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs no LMWH | RR 1.49 [0.06, 36.28] | 4 studies · 1018 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Minor bleeding (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs no LMWH | RR 1.35 [0.62, 2.92] | 2 studies · 544 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Catheter‐related infection (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs no LMWH | RR 0.97 [0.52, 1.79] | 2 studies · 474 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Thrombocytopenia (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs no LMWH | RR 1.03 [0.8, 1.33] | 4 studies · 1002 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vitamin K antagonist (VKA) compared to no VKA for people with cancer and central venous catheters
Population: people with cancer with thrombosis prophylaxis and central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes ( Vitamin K antagonist (VKA) vs no VKA | no estimate extracted | NR | No studies |
All‐cause mortality (up to 3 months) Vitamin K antagonist (VKA) vs no VKA | RR 0.99 [0.64, 1.55] | 4 studies · 701 participants | Low Downgraded: risk of bias |
Symptomatic catheter‐related thrombosis (up to 3 months) Vitamin K antagonist (VKA) vs no VKA | RR 0.61 [0.23, 1.64] | 4 studies · 1271 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Symptomatic catheter‐related thrombosis measured as asymptomatic catheter‐related thrombosis (up to 3 months) Vitamin K antagonist (VKA) vs no VKA | RR 0.61 [0.27, 1.4] | 2 studies · 384 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Major bleeding (up to 3 months) Vitamin K antagonist (VKA) vs no VKA | RR 7.14 [0.88, 57.78] | 2 studies · 1026 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Minor bleeding (up to 3 months) Vitamin K antagonist (VKA) vs no VKA | RR 0.69 [0.38, 1.26] | 2 studies · 1026 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Catheter‐related infection (3 months) Vitamin K antagonist (VKA) vs no VKA | RR 1.17 [0.74, 1.85] | 1 study · 88 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Premature CVC removal (3 months) Vitamin K antagonist (VKA) vs no VKA | RR 0.82 [0.3, 2.24] | 1 study · 88 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Low‐molecular‐weight heparin (LMWH) compared to vitamin K antagonist (VKA) for people with cancer and central venous catheters
Population: people with cancer with thrombosis prophylaxis and central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes ( Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | no estimate extracted | NR | No studies |
All‐cause mortality (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 0.94 [0.56, 1.59] | 3 studies · 561 participants | Low Downgraded: risk of bias |
Symptomatic catheter‐related thrombosis (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 1.83 [0.44, 7.61] | 2 studies · 327 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Symptomatic catheter‐related thrombosis measured as asymptomatic catheter‐related thrombosis (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 1.61 [0.75, 3.46] | 2 studies · 317 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pulmonary embolism (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 1.7 [0.74, 3.92] | 2 studies · 327 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Major bleeding (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 3.11 [0.13, 73.11] | 2 studies · 289 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Minor bleeding (up to 3 months) Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 0.95 [0.2, 4.61] | 1 study · 234 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Thrombocytopenia (up to 3 months)n Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 1.69 [1.2, 2.39] | 2 studies · 327 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Heparin compared with no heparin for thrombosis prophylaxis in people with cancer with central venous catheters
Population: people with cancer with thrombosis prophylaxis and central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Heparin vs no heparin | RR 0.82 [0.53, 1.26] | 5 studies · 1236 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Symptomatic deep venous thrombosis Heparin vs no heparin | RR 0.48 [0.27, 0.86] | 6 studies · 1317 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Major bleeding Heparin vs no heparin | RR 0.49 [0.03, 7.84] | 4 studies · 1012 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Infection Heparin vs no heparin | RR 1 [0.54, 1.85] | 2 studies · 468 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Thrombocytopenia Heparin vs no heparin | RR 1.03 [0.8, 1.33] | 4 studies · 1002 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Quality of life ‐ not reported Heparin vs no heparin | no estimate extracted | NR | No studies |
Vitamin K antagonists (VKA) compared with no VKA for thrombosis prophylaxis in people with cancer with central venous catheters
Population: people with cancer with thrombosis prophylaxis and central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Vitamin K antagonists (VKA) vs no VKA | RR 1.04 [0.89, 1.22] | 5 studies · 1451 participants | Low Downgraded: risk of bias, imprecision |
Symptomatic deep venous thrombosis Vitamin K antagonists (VKA) vs no VKA | RR 0.51 [0.21, 1.22] | 5 studies · 1451 participants | Low Downgraded: risk of bias, imprecision |
Major bleeding Vitamin K antagonists (VKA) vs no VKA | RR 7.6 [0.94, 61.49] | 2 studies · 979 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported Vitamin K antagonists (VKA) vs no VKA | no estimate extracted | NR | No studies |
Low‐molecular‐weight heparin (LMWH) compared with vitamin K antagonist (VKA) for thrombosis prophylaxis in people with cancer with central venous catheters
Population: people with cancer with thrombosis prophylaxis and central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 1.14 [0.59, 2.21] | 113 participants | Very low Downgraded: risk of bias, imprecision |
Symptomatic deep venous thrombosis Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 2.15 [0.65, 7.14] | 3 studies · 551 participants | Very low Downgraded: risk of bias, imprecision |
Major bleeding Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 3.41 [0.15, 79.47] | 2 studies · 279 participants | Very low Downgraded: risk of bias, imprecision |
Thrombocytopenia Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | RR 3.73 [2.26, 6.16] | 2 studies · 317 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported Low‐molecular‐weight heparin (LMWH) vs vitamin K antagonist (VKA) | no estimate extracted | NR | No studies |
Heparin compared to no heparin for thrombosis prophylaxis in cancer patients with central venous catheters
Population: patients with thrombosis prophylaxis in cancer patients with central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Heparin vs no heparin | RR 0.85 [0.53, 1.37] | 5 studies · 1192 participants | Moderate Downgraded: risk of bias, imprecision |
Symptomatic DVT Heparin vs no heparin | RR 0.54 [0.28, 1.05] | 6 studies · 1173 participants | Moderate Downgraded: risk of bias, imprecision |
Major bleeding Heparin vs no heparin | RR 0.68 [0.1, 4.78] | 4 studies · 891 participants | Moderate Downgraded: risk of bias, imprecision |
Infection Heparin vs no heparin | RR 0.91 [0.49, 1.68] | 3 studies · 626 participants | Moderate Downgraded: risk of bias, imprecision |
Thrombocytopenia Heparin vs no heparin | RR 0.85 [0.49, 1.46] | 3 studies · 836 participants | Moderate Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported Heparin vs no heparin | no estimate extracted | NR | No studies |
VKA compared to no VKA for thrombosis prophylaxis in cancer patients with central venous catheters
Population: patients with thrombosis prophylaxis in cancer patients with central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death VKA vs no VKA | RR 0.97 [0.82, 1.15] | 2 studies · 1093 participants | Low Downgraded: risk of bias, imprecision |
Symptomatic DVT VKA vs no VKA | RR 0.63 [0.35, 1.11] | 4 studies · 1235 participants | Low Downgraded: risk of bias, imprecision |
Major bleeding VKA vs no VKA | RR 6.93 [0.86, 56.08] | 2 studies · 1093 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported VKA vs no VKA | no estimate extracted | NR | No studies |
LMWH compared to VKA for thrombosis prophylaxis in cancer patients with central venous catheters
Population: patients with thrombosis prophylaxis in cancer patients with central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death LMWH vs VKA | RR 1.27 [0.55, 2.96] | 2 studies · 343 participants | Low Downgraded: risk of bias, imprecision |
Symptomatic DVT LMWH vs VKA | RR 1.28 [0.25, 6.5] | 2 studies · 280 participants | Low Downgraded: risk of bias, imprecision |
Major bleeding LMWH vs VKA | RR 3.1 [0.13, 73.14] | 2 studies · 343 participants | Low Downgraded: risk of bias, imprecision |
Thrombocytopenia LMWH vs VKA | RR 5.17 [0.26, 103.21] | 1 study · 59 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported LMWH vs VKA | no estimate extracted | NR | No studies |
Heparin compared to no heparin for thrombosis prophylaxis in cancer patients with central venous catheters
Population: patients with thrombosis prophylaxis in cancer patients with central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Heparin vs no heparin | RR 0.85 [0.53, 1.37] | 5 studies · 1192 participants | Moderate Downgraded: risk of bias, imprecision |
Symptomatic DVT Heparin vs no heparin | RR 0.54 [0.28, 1.05] | 6 studies · 1173 participants | Moderate Downgraded: risk of bias, imprecision |
Major bleeding Heparin vs no heparin | RR 0.68 [0.1, 4.78] | 4 studies · 891 participants | Moderate Downgraded: risk of bias, imprecision |
Infection Heparin vs no heparin | RR 0.91 [0.49, 1.68] | 3 studies · 626 participants | Moderate Downgraded: risk of bias, imprecision |
Thrombocytopenia Heparin vs no heparin | RR 0.85 [0.49, 1.46] | 3 studies · 836 participants | Moderate Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported Heparin vs no heparin | no estimate extracted | NR | No studies |
VKA compared to no VKA for thrombosis prophylaxis in cancer patients with central venous catheters
Population: patients with thrombosis prophylaxis in cancer patients with central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death VKA vs no VKA | RR 0.97 [0.82, 1.15] | 2 studies · 1093 participants | Low Downgraded: risk of bias, imprecision |
Symptomatic DVT VKA vs no VKA | RR 0.63 [0.35, 1.11] | 4 studies · 1235 participants | Low Downgraded: risk of bias, imprecision |
Major bleeding VKA vs no VKA | RR 6.93 [0.86, 56.08] | 2 studies · 1093 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported VKA vs no VKA | no estimate extracted | NR | No studies |
LMWH compared to VKA for thrombosis prophylaxis in cancer patients with central venous catheters
Population: patients with thrombosis prophylaxis in cancer patients with central venous catheters
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death LMWH vs VKA | RR 1.27 [0.55, 2.96] | 2 studies · 343 participants | Low Downgraded: risk of bias, imprecision |
Symptomatic DVT LMWH vs VKA | RR 1.28 [0.25, 6.5] | 2 studies · 280 participants | Low Downgraded: risk of bias, imprecision |
Major bleeding LMWH vs VKA | RR 3.1 [0.13, 73.14] | 2 studies · 343 participants | Low Downgraded: risk of bias, imprecision |
Thrombocytopenia LMWH vs VKA | RR 5.17 [0.26, 103.21] | 1 study · 59 participants | Low Downgraded: risk of bias, imprecision |
Quality of life ‐ not reported LMWH vs VKA | no estimate extracted | NR | No studies |
Comparison
Population: patients with cancer and a central venous line for thromboprophylaxis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death | RR 0.74 [0.4, 1.36] | 3 studies · 913 participants | Moderate |
Symptomatic DVT | RR 0.43 [0.18, 1.06] | 4 studies · 852 participants | Moderate |
Major bleeding | RR 0.68 [0.1, 4.78] | 2 studies · 499 participants | Low |
Thrombocytopenia | RR 0.85 [0.49, 4.46] | 3 studies · 836 participants | Moderate |
Comparison
Population: patients with cancer and a central venous line for thromboprophylaxis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic DVT | RR 0.62 [0.3, 1.27] | 3 studies · 1007 participants | Moderate |