Cochrane · systematic review · CD006650
Anticoagulation for the long‐term treatment of venous thromboembolism in people with cancer
Kahale, LA, Hakoum, MB, Tsolakian, IG, 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
30
current version
GRADE rated
27
No studies
3
Included studies
NR
No studies 3 · 10%Ungraded 0 · 0%Very low 6 · 20%Low 15 · 50%Moderate 6 · 20%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 secondary prophylaxis compared to vitamin K antagonist secondary prophylaxis in people with cancer with venous thromboembolism
Population: People with cancer with venous thromboembolism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality (main analysis ‐ active cancer) Low molecular weight heparin secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 0.99 [0.88, 1.12] | 4 studies · 1712 participants | Low Downgraded: risk of bias, imprecision |
All‐cause mortality (time‐to‐event) Low molecular weight heparin secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | HR 0.94 [0.74, 1.2] | 2 studies · 1243 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Recurrent venous thromboembolism (main analysis ‐ active cancer) Low molecular weight heparin secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 0.59 [0.44, 0.8] | 4 studies · 1712 participants | Moderate Downgraded: risk of bias, imprecision |
Recurrent venous thromboembolism (time‐to‐event) Low molecular weight heparin secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | HR 0.49 [0.31, 0.78] | 2 studies · 1243 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Major bleeding (main analysis ‐ active cancer) Low molecular weight heparin secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 1.09 [0.55, 2.12] | 4 studies · 1712 participants | Low Downgraded: risk of bias, imprecision |
Minor bleeding (main analysis ‐ active cancer) Low molecular weight heparin secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 0.78 [0.47, 1.27] | 4 studies · 1712 participants | Very low Downgraded: risk of bias, imprecision |
Thrombocytopenia (main analysis‐ active cancer) Low molecular weight heparin secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 0.94 [0.52, 1.69] | 1 study · 138 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Direct oral anticoagulant secondary prophylaxis compared to Vitamin K antagonist secondary prophylaxis in patients with active cancer with venous thromboembolism
Population: patients with active cancer with venous thromboembolism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Direct oral anticoagulant secondary prophylaxis vs Vitamin K antagonist secondary prophylaxis | RR 0.94 [0.72, 1.23] | 4 studies · 1060 participants | Low Downgraded: inconsistency, indirectness |
Recurrent venous thromboembolism Direct oral anticoagulant secondary prophylaxis vs Vitamin K antagonist secondary prophylaxis | RR 0.63 [0.34, 1.15] | 4 studies · 1050 participants | Low Downgraded: inconsistency, indirectness |
Major bleeding Direct oral anticoagulant secondary prophylaxis vs Vitamin K antagonist secondary prophylaxis | RR 0.77 [0.39, 1.53] | 4 studies · 1055 participants | Low Downgraded: inconsistency, indirectness |
Minor bleeding Direct oral anticoagulant secondary prophylaxis vs Vitamin K antagonist secondary prophylaxis | RR 0.83 [0.57, 1.23] | 4 studies · 1055 participants | Low Downgraded: inconsistency, indirectness |
Thrombocytopenia ‐ not reported Direct oral anticoagulant secondary prophylaxis vs Vitamin K antagonist secondary prophylaxis | no estimate extracted | NR | No studies |
Health related quality of life Direct oral anticoagulant secondary prophylaxis vs Vitamin K antagonist secondary prophylaxis | no estimate extracted | 1 study · 8485 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Direct oral anticoagulant secondary prophylaxis compared to Low molecular weight heparin secondary prophylaxis in patients with cancer with venous thromboembolism
Population: patients with cancer with venous thromboembolism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 0.97 [0.83, 1.14] | 5 studies · 2854 participants | Low Downgraded: risk of bias, imprecision |
Recurrent VTE Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 0.63 [0.45, 0.88] | 5 studies · 2854 participants | Low Downgraded: risk of bias, imprecision |
Major bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.2 [0.83, 1.73] | 5 studies · 2994 participants | Low Downgraded: risk of bias, imprecision |
Major GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.16 [0.62, 2.17] | 4 studies · 1838 participants | Low Downgraded: risk of bias, imprecision |
Major upper GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.18 [0.51, 2.76] | 4 studies · 1838 participants | Very low Downgraded: risk of bias, imprecision |
Major lower GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.1 [0.43, 2.8] | 4 studies · 1838 participants | Very low Downgraded: risk of bias, imprecision |
Major non‐GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 0.84 [0.42, 1.68] | 4 studies · 1838 participants | Very low Downgraded: risk of bias, imprecision |
Minor bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.58 [1.15, 2.16] | 5 studies · 2854 participants | Moderate Downgraded: risk of bias, imprecision |
Minor GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.37 [0.41, 4.64] | 2 studies · 1495 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Minor upper GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.03 [0.04, 25.97] | 2 studies · 1495 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Minor lower GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 1.54 [0.72, 3.27] | 2 studies · 1495 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Minor non‐GI bleeding Direct oral anticoagulant secondary prophylaxis vs Low molecular weight heparin secondary prophylaxis | RR 2.37 [1.44, 3.89] | 2 studies · 1495 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Idraparinux secondary prophylaxis compared to vitamin K antagonist secondary prophylaxis in people with cancer with venous thromboembolism
Population: people with cancer with VTE receiving secondary prophylaxis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Idraparinux secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 1.11 [0.78, 1.59] | 1 study · 284 participants | Moderate Downgraded: imprecision |
Recurrent VTE Idraparinux secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 0.46 [0.16, 1.32] | 1 study · 270 participants | Low Downgraded: imprecision |
Major bleeding Idraparinux secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | RR 1.11 [0.35, 3.56] | 1 study · 270 participants | Low Downgraded: imprecision |
Minor bleeding – not reported Idraparinux secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | no estimate extracted | NR | No studies |
Health‐related quality of life – not reported Idraparinux secondary prophylaxis vs vitamin K antagonist secondary prophylaxis | no estimate extracted | NR | No studies |
Low molecular weight heparin compared with vitamin K antagonist for patients with cancer requiring long‐term anticoagulation for venous thromboembolism
Population: patients with cancer requiring long‐term anticoagulation for VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Low molecular weight heparin vs vitamin K antagonist | RR 0.96 [0.81, 1.13] | 3 studies · 897 participants | Low |
Recurrent VTE Low molecular weight heparin vs vitamin K antagonist | RR 0.51 [0.35, 0.76] | 4 studies · 964 participants | Moderate |
Major bleeding Low molecular weight heparin vs vitamin K antagonist | RR 1.07 [0.52, 2.19] | 4 studies · 1092 participants | Low |
Minor bleeding Low molecular weight heparin vs vitamin K antagonist | RR 0.89 [0.51, 1.55] | 4 studies · 1091 participants | Low |
Postphlebitic syndrome ‐ not reported Low molecular weight heparin vs vitamin K antagonist | no estimate extracted | NR | No studies |
LMWH compared to VKA for patients with cancer requiring long‐term anticoagulation for VTE
Population: Patients with cancer requiring long‐term anticoagulation for VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality LMWH vs VKA | RR 0.95 [0.81, 1.11] | 6 studies · 1346 participants | Low |
Recurrent VTE LMWH vs VKA | RR 0.49 [0.34, 0.7] | 5 studies · 1178 participants | Moderate |
Major bleeding LMWH vs VKA | RR 1.05 [0.53, 2.1] | 4 studies · 1120 participants | Low |
Minor bleeding LMWH vs VKA | RR 0.85 [0.53, 1.35] | 4 studies · 1120 participants | Low |
Postphlebitic syndrome ‐ not reported LMWH vs VKA | no estimate extracted | NR | No studies |
Comparison
Population: patients with cancer requiring long term anticoagulation for VTE
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality ( | RR 0.95 [0.81, 1.11] | 4 studies · 1346 participants | Low |
Recurrent VTE (binary) ( | RR 0.51 [0.35, 0.74] | 4 studies · 1109 participants | Moderate Downgraded: inconsistency |
Major bleeding ( | RR 1.05 [0.53, 2.1] | 4 studies · 1120 participants | Low Downgraded: inconsistency |
Minor bleeding ( | RR 0.85 [0.53, 1.35] | 4 studies · 1120 participants | Very low Downgraded: inconsistency |