Cochrane · systematic review · CD006649
Anticoagulation for the initial treatment of venous thromboembolism in people with cancer
Kahale, LA, Matar, CF, Hakoum, MB, 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
24
current version
GRADE rated
10
No studies
14
Included studies
NR
No studies 14 · 58.3%Ungraded 0 · 0%Very low 0 · 0%Low 9 · 37.5%Moderate 1 · 4.2%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 compared to unfractionated heparin
Population: people with cancer with venous thromboembolism (VTE)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Mortality Low molecular weight heparin vs unfractionated heparin | RR 0.66 [0.4, 1.1] | 5 studies · 418 participants | Low Downgraded: imprecision |
Recurrent VTE Low molecular weight heparin vs unfractionated heparin | RR 0.69 [0.27, 1.76] | 3 studies · 422 participants | Low Downgraded: imprecision |
Major bleeding ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Minor bleeding ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Postphlebitic syndrome ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Fondaparinux compared to heparin
Population: people with cancer with VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Mortality Fondaparinux vs heparin | RR 1.25 [0.86, 1.81] | 1 study · 477 participants | Low Downgraded: imprecision |
Recurrent VTE Fondaparinux vs heparin | RR 0.93 [0.56, 1.54] | 1 study · 477 participants | Low Downgraded: imprecision |
Major bleeding Fondaparinux vs heparin | RR 0.82 [0.4, 1.66] | 1 study · 477 participants | Low Downgraded: imprecision |
Minor bleeding Fondaparinux vs heparin | RR 1.53 [0.88, 2.66] | 1 study · 477 participants | Moderate Downgraded: imprecision |
Quality of life ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Postphlebitic syndrome ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Dalteparin compared to tinzaparin
Population: initial treatment in people with cancer with VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes Dalteparin vs tinzaparin | no estimate extracted | NR | No studies |
Mortality Dalteparin vs tinzaparin | RR 0.86 [0.43, 1.73] | 1 study · 113 participants | Low Downgraded: imprecision |
Recurrent VTE Dalteparin vs tinzaparin | RR 0.44 [0.09, 2.16] | 1 study · 113 participants | Low Downgraded: imprecision |
Major bleeding Dalteparin vs tinzaparin | RR 2.19 [0.2, 23.42] | 1 study · 113 participants | Low Downgraded: imprecision |
Minor bleeding Dalteparin vs tinzaparin | RR 0.82 [0.3, 2.21] | 1 study · 113 participants | Low Downgraded: imprecision |
Quality of life ‐ not reported Dalteparin vs tinzaparin | no estimate extracted | NR | No studies |
Postphlebitic syndrome ‐ not reported Dalteparin vs tinzaparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Dalteparin vs tinzaparin | no estimate extracted | NR | No studies |
LMWH initial treatment compared to UFH initial treatment in people with cancer with VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality LMWH initial treatment vs UFH initial treatment | RR 0.66 [0.4, 1.1] | 5 studies · 418 participants | Moderate |
Recurrent VTE LMWH initial treatment vs UFH initial treatment | RR 0.69 [0.27, 1.76] | 3 studies · 422 participants | Moderate |
Fondaparinux initial treatment compared to Heparin initial treatment in patients with cancer with VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Fondaparinux initial treatment vs Heparin initial treatment | RR 1.25 [0.86, 1.81] | 1 study · 477 participants | Moderate |
Recurrent VTE Fondaparinux initial treatment vs Heparin initial treatment | RR 0.93 [0.56, 1.54] | 1 study · 477 participants | Moderate |
Major bleeding Fondaparinux initial treatment vs Heparin initial treatment | RR 0.82 [0.4, 1.66] | 1 study · 477 participants | Moderate |
Minor bleeding Fondaparinux initial treatment vs Heparin initial treatment | RR 1.53 [0.88, 2.66] | 1 study · 477 participants | Moderate |
Quality of life ‐ not reported Fondaparinux initial treatment vs Heparin initial treatment | no estimate extracted | NR | No studies |
Dalteparin compared to tinzaparin in people with cancer with VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Dalteparin vs tinzaparin | RR 0.86 [0.43, 1.73] | 1 study · 113 participants | Low |
Recurrent VTE Dalteparin vs tinzaparin | RR 0.44 [0.09, 2.16] | 1 study · 113 participants | Low |
Major bleeding Dalteparin vs tinzaparin | RR 2.19 [0.2, 23.42] | 1 study · 113 participants | Low |
Minor bleeding Dalteparin vs tinzaparin | RR 0.82 [0.3, 2.21] | 1 study · 113 participants | Low |
Low molecular weight heparin compared with unfractionated heparin for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with cancer with the initial treatment of VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at 3 months Low molecular weight heparin vs unfractionated heparin | RR 0.71 [0.52, 0.98] | 11 studies · 801 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Recurrent VTE Low molecular weight heparin vs unfractionated heparin | RR 0.78 [0.29, 2.08] | 3 studies · 371 participants | Low |
Major bleeding ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Postphlebitic syndrome ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Low molecular weight heparin vs unfractionated heparin | no estimate extracted | NR | No studies |
Fondaparinux compared with heparin for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with cancer with the initial treatment of VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Fondaparinux vs heparin | RR 1.27 [0.88, 1.84] | 2 studies · 477 participants | Moderate Downgraded: risk of bias |
Recurrent VTE Fondaparinux vs heparin | RR 0.95 [0.57, 1.6] | 2 studies · 477 participants | Low Downgraded: risk of bias, inconsistency |
Major bleeding Fondaparinux vs heparin | RR 0.79 [0.39, 1.63] | 2 studies · 477 participants | Moderate Downgraded: risk of bias, inconsistency |
Minor bleeding Fondaparinux vs heparin | RR 1.5 [0.87, 2.59] | 2 studies · 477 participants | Moderate |
Postphlebitic syndrome ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
LMWH compared to UFH for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with the initial treatment of venous thromboembolism in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at 3 months LMWH vs UFH | RR 0.71 [0.52, 0.98] | 11 studies · 801 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Recurrent VTE LMWH vs UFH | RR 0.78 [0.29, 2.08] | 3 studies · 371 participants | Low Downgraded: risk of bias, publication bias |
Major bleeding ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Post phlebitic syndrome ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Quality of life ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Fondaparinux compared to heparin for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with the initial treatment of venous thromboembolism in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Fondaparinux vs heparin | RR 1.27 [0.88, 1.84] | 2 studies · 477 participants | Moderate Downgraded: risk of bias |
Recurrent VTE Fondaparinux vs heparin | RR 0.95 [0.57, 1.6] | 2 studies · 477 participants | Low Downgraded: risk of bias, inconsistency |
Major bleeding Fondaparinux vs heparin | RR 0.79 [0.39, 1.63] | 2 studies · 477 participants | Moderate Downgraded: risk of bias, inconsistency |
Minor bleeding Fondaparinux vs heparin | RR 1.5 [0.87, 2.59] | 2 studies · 477 participants | Moderate Downgraded: inconsistency |
Post phlebitic syndrome ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
LMWH compared to UFH for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with the initial treatment of venous thromboembolism in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at 3 months LMWH vs UFH | RR 0.71 [0.52, 0.98] | 11 studies · 801 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Recurrent VTE LMWH vs UFH | RR 0.78 [0.29, 2.08] | 3 studies · 371 participants | Low Downgraded: risk of bias, publication bias |
Major bleeding ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Post phlebitic syndrome ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Quality of life ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Fondaparinux compared to heparin for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with the initial treatment of venous thromboembolism in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Fondaparinux vs heparin | RR 1.27 [0.88, 1.84] | 2 studies · 477 participants | Moderate Downgraded: risk of bias |
Recurrent VTE Fondaparinux vs heparin | RR 0.95 [0.57, 1.6] | 2 studies · 477 participants | Low Downgraded: risk of bias, inconsistency |
Major bleeding Fondaparinux vs heparin | RR 0.79 [0.39, 1.63] | 2 studies · 477 participants | Moderate Downgraded: risk of bias, inconsistency |
Minor bleeding Fondaparinux vs heparin | RR 1.5 [0.87, 2.59] | 2 studies · 477 participants | Moderate Downgraded: inconsistency |
Post phlebitic syndrome ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
LMWH compared to UFH for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with the initial treatment of venous thromboembolism in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at 3 months LMWH vs UFH | RR 0.71 [0.52, 0.98] | 11 studies · 801 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Recurrent VTE LMWH vs UFH | RR 0.78 [0.29, 2.08] | 3 studies · 371 participants | Low Downgraded: risk of bias, publication bias |
Major bleeding ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Post phlebitic syndrome ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Quality of life ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported LMWH vs UFH | no estimate extracted | NR | No studies |
Fondaparinux compared to heparin for the initial treatment of venous thromboembolism in patients with cancer
Population: patients with the initial treatment of venous thromboembolism in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Fondaparinux vs heparin | RR 1.27 [0.88, 1.84] | 2 studies · 477 participants | Moderate Downgraded: risk of bias |
Recurrent VTE Fondaparinux vs heparin | RR 0.95 [0.57, 1.6] | 2 studies · 477 participants | Low Downgraded: risk of bias, inconsistency |
Major bleeding Fondaparinux vs heparin | RR 0.79 [0.39, 1.63] | 2 studies · 477 participants | Moderate Downgraded: risk of bias, inconsistency |
Minor bleeding Fondaparinux vs heparin | RR 1.5 [0.87, 2.59] | 2 studies · 477 participants | Moderate Downgraded: inconsistency |
Post phlebitic syndrome ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Thrombocytopenia ‐ not reported Fondaparinux vs heparin | no estimate extracted | NR | No studies |
Comparison
Population: patients with cancer requiring initial anticoagulation for venous thromboembolism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death ( | RR 0.71 [0.51, 0.97] | 11 studies · 801 participants | Moderate Downgraded: publication bias |
Recurrent venous thromboembolism ( | RR 0.78 [0.29, 2.08] | 3 studies · 371 participants | Low Downgraded: publication bias |