Cochrane · systematic review · CD008500
Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy
Rutjes, AWS, Porreca, E, Candeloro, M, et al. · Cochrane Database of Systematic Reviews · 2020 · 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
70
current version
GRADE rated
40
No studies
27
Included studies
NR
No studies 27 · 38.6%Ungraded 3 · 4.3%Very low 3 · 4.3%Low 12 · 17.1%Moderate 18 · 25.7%High 7 · 10%
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
Show all 4 versionsDOAC versus placebo
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE DOAC vs placebo | RR 0.43 [0.18, 1.06] | 3 studies · 1526 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Major bleeding DOAC vs placebo | RR 1.74 [0.82, 3.68] | 3 studies · 1494 participants | Moderate Downgraded: risk of bias, imprecision |
Symptomatic PE DOAC vs placebo | RR 0.38 [0.1, 1.47] | 3 studies · 1526 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Symptomatic DVT DOAC vs placebo | RR 0.51 [0.21, 1.22] | 3 studies · 1526 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Any VTE DOAC vs placebo | RR 0.55 [0.34, 0.9] | 2 studies · 1404 participants | Moderate Downgraded: risk of bias, imprecision |
1‐year overall mortality DOAC vs placebo | no estimate extracted | 0 studies · 0 participants | Ungraded |
Clinically relevant bleeding DOAC vs placebo | RR 1.61 [0.82, 3.15] | 2 studies · 931 participants | Moderate Downgraded: risk of bias, imprecision |
Low‐molecular‐weight heparin versus no thromboprophylaxis
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Low‐molecular‐weight heparin vs no thromboprophylaxis | RR 0.62 [0.46, 0.83] | 11 studies · 3931 participants | High |
Major bleeding Low‐molecular‐weight heparin vs no thromboprophylaxis | RR 1.63 [1.12, 2.35] | 15 studies · 7282 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Symptomatic PE Low‐molecular‐weight heparin vs no thromboprophylaxis | RR 0.6 [0.42, 0.88] | 8 studies · 5324 participants | Moderate Downgraded: risk of bias |
Symptomatic DVT Low‐molecular‐weight heparin vs no thromboprophylaxis | RR 0.48 [0.35, 0.67] | 9 studies · 5408 participants | High |
Any VTE Low‐molecular‐weight heparin vs no thromboprophylaxis | RR 0.57 [0.46, 0.71] | 10 studies · 5743 participants | High |
1‐year overall mortality Low‐molecular‐weight heparin vs no thromboprophylaxis | RR 0.94 [0.83, 1.07] | 9 studies · 2681 participants | Low Downgraded: inconsistency |
Clinically relevant bleeding Low‐molecular‐weight heparin vs no thromboprophylaxis | RR 3.4 [1.2, 9.63] | 4 studies · 3105 participants | Moderate |
Low‐molecular‐weight heparin versus with active control (1)
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Low‐molecular‐weight heparin vs with active control (1) | RR 2.89 [0.12, 66.75] | 1 study · 51 participants | Low Downgraded: imprecision |
Major bleeding Low‐molecular‐weight heparin vs with active control (1) | no estimate extracted | NR | No studies |
Symptomatic PE Low‐molecular‐weight heparin vs with active control (1) | RR 2.89 [0.12, 66.75] | NR | Ungraded |
Symptomatic DVT Low‐molecular‐weight heparin vs with active control (1) | no estimate extracted | NR | No studies |
Any VTE Low‐molecular‐weight heparin vs with active control (1) | RR 4.81 [0.24, 95.58] | NR | Ungraded |
1‐year overall mortality Low‐molecular‐weight heparin vs with active control (1) | no estimate extracted | NR | No studies |
Clinically relevant bleeding Low‐molecular‐weight heparin vs with active control (1) | no estimate extracted | NR | No studies |
Low‐molecular‐weight heparin versus active control (2)
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Low‐molecular‐weight heparin vs active control (2) | RR 0.51 [0.22, 1.17] | 2 studies · 781 participants | Moderate Downgraded: imprecision |
Major bleeding Low‐molecular‐weight heparin vs active control (2) | RR 0.14 [0.01, 2.76] | 2 studies · 781 participants | Low Downgraded: imprecision |
Symptomatic PE Low‐molecular‐weight heparin vs active control (2) | RR 0.13 [0.02, 1.03] | 2 studies · 781 participants | Moderate Downgraded: imprecision |
Symptomatic DVT Low‐molecular‐weight heparin vs active control (2) | RR 0.81 [0.32, 2.04] | 2 studies · 781 participants | Moderate Downgraded: imprecision |
Any VTE Low‐molecular‐weight heparin vs active control (2) | no estimate extracted | NR | No studies |
1‐year overall mortality Low‐molecular‐weight heparin vs active control (2) | no estimate extracted | NR | No studies |
Clinically relevant bleeding Low‐molecular‐weight heparin vs active control (2) | no estimate extracted | NR | No studies |
Low‐molecular‐weight heparin versus active control (3)
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Low‐molecular‐weight heparin vs active control (3) | RR 0.33 [0.14, 0.83] | 1 study · 439 participants | High |
Major bleeding Low‐molecular‐weight heparin vs active control (3) | no estimate extracted | NR | No studies |
Symptomatic PE Low‐molecular‐weight heparin vs active control (3) | RR 0.11 [0.01, 2.06] | 1 study · 439 participants | Low Downgraded: imprecision |
Symptomatic DVT Low‐molecular‐weight heparin vs active control (3) | RR 0.43 [0.17, 1.1] | 1 study · 439 participants | Moderate Downgraded: imprecision |
Any VTE Low‐molecular‐weight heparin vs active control (3) | no estimate extracted | NR | No studies |
1‐year overall mortality Low‐molecular‐weight heparin vs active control (3) | no estimate extracted | NR | No studies |
Clinically relevant bleeding Low‐molecular‐weight heparin vs active control (3) | no estimate extracted | NR | No studies |
Ultra‐low‐molecular‐weight heparin versus placebo
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Ultra‐low‐molecular‐weight heparin vs placebo | RR 0.36 [0.22, 0.6] | 1 study · 3212 participants | High |
Major bleeding Ultra‐low‐molecular‐weight heparin vs placebo | RR 1.05 [0.55, 2] | 1 study · 3172 participants | Moderate Downgraded: imprecision |
Symptomatic PE Ultra‐low‐molecular‐weight heparin vs placebo | RR 0.48 [0.22, 1.01] | 1 study · 3212 participants | Moderate Downgraded: imprecision |
Symptomatic DVT Ultra‐low‐molecular‐weight heparin vs placebo | RR 0.32 [0.16, 0.63] | 1 study · 3212 participants | High |
Any VTE Ultra‐low‐molecular‐weight heparin vs placebo | RR 0.36 [0.22, 0.6] | 1 study · 3212 participants | High |
1‐year overall mortality Ultra‐low‐molecular‐weight heparin vs placebo | RR 1.02 [0.96, 1.08] | 1 study · 3212 participants | Moderate Downgraded: imprecision |
Clinically relevant bleeding Ultra‐low‐molecular‐weight heparin vs placebo | RR 1.4 [0.9, 2.19] | 1 study · 3172 participants | Moderate Downgraded: imprecision |
Unfractionated heparin versus no thromboprophylaxis
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Unfractionated heparin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Major bleeding Unfractionated heparin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Symptomatic PE Unfractionated heparin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Symptomatic DVT Unfractionated heparin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Any VTE Unfractionated heparin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
1‐year overall mortality Unfractionated heparin vs no thromboprophylaxis | RR 0.86 [0.72, 1.03] | 1 study · 277 participants | Moderate Downgraded: imprecision |
Clinically relevant bleeding Unfractionated heparin vs no thromboprophylaxis | RR 2.01 [0.18, 21.96] | 1 study · 277 participants | Low Downgraded: imprecision |
Vitamin K antagonists versus placebo or no thromboprophylaxis
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Vitamin K antagonists vs placebo or no thromboprophylaxis | RR 0.15 [0.02, 1.2] | 1 study · 311 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Major bleeding Vitamin K antagonists vs placebo or no thromboprophylaxis | RR 3.82 [0.97, 15.04] | 4 studies · 994 participants | Low Downgraded: risk of bias, imprecision |
Symptomatic PE Vitamin K antagonists vs placebo or no thromboprophylaxis | RR 1.05 [0.07, 16.58] | 1 study · 311 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Symptomatic DVT Vitamin K antagonists vs placebo or no thromboprophylaxis | RR 0.08 [0, 1.42] | 1 study · 311 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Any VTE Vitamin K antagonists vs placebo or no thromboprophylaxis | no estimate extracted | NR | No studies |
1‐year overall mortality Vitamin K antagonists vs placebo or no thromboprophylaxis | no estimate extracted | NR | No studies |
Clinically relevant bleeding Vitamin K antagonists vs placebo or no thromboprophylaxis | no estimate extracted | NR | No studies |
Vitamin K antagonists versus active control
Population: ambulatory cancer patients receiving chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Vitamin K antagonists vs active control | RR 1.5 [0.74, 3.04] | 1 study · 440 participants | Moderate Downgraded: risk of bias, imprecision |
Major bleeding Vitamin K antagonists vs active control | RR 0.14 [0.01, 2.75] | 1 study · 440 participants | Low Downgraded: risk of bias, imprecision |
Symptomatic PE Vitamin K antagonists vs active control | RR 1 [0.25, 3.95] | 1 study · 440 participants | Moderate Downgraded: risk of bias, imprecision |
Symptomatic DVT Vitamin K antagonists vs active control | RR 1.75 [0.75, 4.09] | 1 study · 440 participants | Moderate Downgraded: risk of bias, imprecision |
Any VTE Vitamin K antagonists vs active control | no estimate extracted | NR | No studies |
1‐year overall mortality Vitamin K antagonists vs active control | no estimate extracted | NR | No studies |
Clinically relevant bleeding Vitamin K antagonists vs active control | no estimate extracted | NR | No studies |
Antithrombin versus no thromboprophylaxis
Population: ambulatory paediatric cancer patients newly diagnosed with acute lymphoblastic leukaemia who received chemotherapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic VTE Antithrombin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Major bleeding Antithrombin vs no thromboprophylaxis | RR 0.78 [0.03, 18.57] | 1 study · 85 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Symptomatic PE Antithrombin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Symptomatic DVT Antithrombin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Any VTE Antithrombin vs no thromboprophylaxis | RR 0.84 [0.41, 1.73] | 1 study · 85 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
1‐year overall mortality Antithrombin vs no thromboprophylaxis | no estimate extracted | NR | No studies |
Clinically relevant bleeding Antithrombin vs no thromboprophylaxis | no estimate extracted | NR | No studies |