Cochrane · systematic review · CD006652
Parenteral anticoagulation in ambulatory patients with cancer
Akl, EA, Kahale, LA, Hakoum, MB, et al. · Cochrane Database of Systematic Reviews · 2017 · 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
7
current version
GRADE rated
7
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 0 · 0%Moderate 5 · 71.4%High 2 · 28.6%
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 onlyHeparin prophylaxis compared with no prophylaxis in ambulatory patients with cancer without VTE receiving systemic therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Heparin prophylaxis vs no prophylaxis | RR 0.98 [0.93, 1.03] | 18 studies · 9575 participants | Moderate Downgraded: imprecision |
Mortality Heparin prophylaxis vs no prophylaxis | RR 0.99 [0.96, 1.01] | 14 studies · 5229 participants | Moderate Downgraded: imprecision |
Symptomatic VTE Heparin prophylaxis vs no prophylaxis | RR 0.56 [0.47, 0.68] | 16 studies · 9036 participants | High |
Major bleeding Heparin prophylaxis vs no prophylaxis | RR 1.3 [0.94, 1.79] | 18 studies · 9592 participants | Moderate Downgraded: risk of bias, imprecision |
Minor bleeding Heparin prophylaxis vs no prophylaxis | RR 1.7 [1.13, 2.55] | 16 studies · 9245 participants | High |
Thrombocytopenia Heparin prophylaxis vs no prophylaxis | RR 0.69 [0.37, 1.27] | 12 studies · 5832 participants | Moderate Downgraded: risk of bias, imprecision |
Quality of life impairment Heparin prophylaxis vs no prophylaxis | no estimate extracted | 2 studies · 2241 participants | Moderate Downgraded: risk of bias, imprecision |
Heparin compared to placebo for ambulatory patients with cancer who have no therapeutic or prophylactic indication for anticoagulation
Population: Ambulatory patients with cancer who have no therapeutic or prophylactic indication for anticoagulation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality at 12 months Heparin vs placebo | RR 0.97 [0.92, 1.01] | 13 studies · 7013 participants | Moderate |
Symptomatic VTE Heparin vs placebo | RR 0.56 [0.42, 0.74] | 13 studies · 6809 participants | High |
Major bleeding Heparin vs placebo | RR 1.14 [0.7, 1.85] | 15 studies · 7363 participants | Moderate |
Minor bleeding Heparin vs placebo | RR 1.32 [1.02, 1.71] | 13 studies · 6884 participants | Moderate |
heparin compared to no heparin for patients with cancer who have no other therapeutic or prophylactic indication for anticoagulation
Population: patients with cancer who have no other therapeutic or prophylactic indication for anticoagulation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality heparin vs no heparin | RR 0.93 [0.85, 1.02] | 8 studies · 2531 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Symptomatic VTE heparin vs no heparin | RR 0.55 [0.37, 0.82] | 7 studies · 2264 participants | High |
Major bleeding heparin vs no heparin | RR 1.3 [0.59, 2.88] | 9 studies · 2843 participants | Moderate Downgraded: risk of bias |
Minor bleeding heparin vs no heparin | RR 1.05 [0.75, 1.46] | 7 studies · 2345 participants | Moderate Downgraded: risk of bias |
Health related quality of life the Uniscale and the Symptom Distress Scale (SDS); Better indicated by lower values heparin vs no heparin | no estimate extracted | 0 studies · 1 participants | Low Downgraded: risk of bias |
heparin compared to no heparin for patients with cancer who have no other therapeutic or prophylactic indication for anticoagulation
Population: patients with cancer who have no other therapeutic or prophylactic indication for anticoagulation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality heparin vs no heparin | RR 0.93 [0.85, 1.02] | 8 studies · 2531 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Symptomatic VTE heparin vs no heparin | RR 0.55 [0.37, 0.82] | 7 studies · 2264 participants | High |
Major bleeding heparin vs no heparin | RR 1.3 [0.59, 2.88] | 9 studies · 2843 participants | Moderate Downgraded: risk of bias |
Minor bleeding heparin vs no heparin | RR 1.05 [0.75, 1.46] | 7 studies · 2345 participants | Moderate Downgraded: risk of bias |
Health related quality of life the Uniscale and the Symptom Distress Scale (SDS); Better indicated by lower values heparin vs no heparin | no estimate extracted | 0 studies · 1 participants | Low Downgraded: risk of bias |
Comparison
Population: prolonging survival of patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Survival at 12 months study | RR 0.87 [0.8, 0.95] | 5 studies · 1174 participants | High |
Survival (overall) study | HR 0.77 [0.65, 0.91] | 5 studies · 1174 participants | High |
DVT | RR 0.61 [0.08, 4.91] | 2 studies · 458 participants | Very low Downgraded: risk of bias, indirectness |
Major bleeding | RR 1.5 [0.26, 8.8] | 3 studies · 814 participants | Low Downgraded: risk of bias, indirectness |
Minor bleeding | RR 2.07 [0.78, 5.51] | 3 studies · 760 participants | Low Downgraded: risk of bias, indirectness |