Cochrane · systematic review · CD009447
Anticoagulation for perioperative thromboprophylaxis in people with cancer
Matar, CF, Kahale, LA, 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
20
current version
GRADE rated
19
No studies
1
Included studies
NR
No studies 1 · 5%Ungraded 0 · 0%Very low 0 · 0%Low 9 · 45%Moderate 10 · 50%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 onlyLMWH prophylaxis compared to UFH prophylaxis in people with cancer without VTE undergoing a surgery
Population: People with cancer with perioperative thromboprophylaxis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality LMWH prophylaxis vs UFH prophylaxis | RR 0.82 [0.63, 1.07] | 8 studies · 4260 participants | Moderate Downgraded: imprecision |
Any PE LMWH prophylaxis vs UFH prophylaxis | RR 0.49 [0.17, 1.47] | 14 studies · 5588 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Symptomatic DVT LMWH prophylaxis vs UFH prophylaxis | RR 0.67 [0.27, 1.69] | 8 studies · 2250 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Symptomatic DVT measured as asymptomatic DVT LMWH prophylaxis vs UFH prophylaxis | RR 0.86 [0.71, 1.05] | 12 studies · 4938 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Major bleeding LMWH prophylaxis vs UFH prophylaxis | RR 1.01 [0.69, 1.48] | 9 studies · 3473 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Minor bleeding LMWH prophylaxis vs UFH prophylaxis | RR 1.01 [0.76, 1.33] | 2 studies · 1194 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Wound hematoma LMWH prophylaxis vs UFH prophylaxis | RR 0.7 [0.54, 0.92] | 6 studies · 2827 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Reoperation for bleeding LMWH prophylaxis vs UFH prophylaxis | RR 0.93 [0.57, 1.5] | 4 studies · 1246 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Intraoperative transfusion LMWH prophylaxis vs UFH prophylaxis | no estimate extracted | 2 studies · 737 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Postoperative transfusion LMWH prophylaxis vs UFH prophylaxis | no estimate extracted | 2 studies · 734 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Intraoperative blood loss LMWH prophylaxis vs UFH prophylaxis | no estimate extracted | 4 studies · 761 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Postoperative drain volume LMWH prophylaxis vs UFH prophylaxis | no estimate extracted | 3 studies · 1459 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Thrombocytopenia LMWH prophylaxis vs UFH prophylaxis | RR 3.07 [0.32, 29.33] | 2 studies · 683 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
LMWH prophylaxis compared to fondaparinux prophylaxis in people with cancer without VTE undergoing a surgical procedure
Population: People with perioperative thromboprophylaxis in people with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality ‐ not reported LMWH prophylaxis vs fondaparinux prophylaxis | no estimate extracted | NR | No studies |
Any VTE LMWH prophylaxis vs fondaparinux prophylaxis | RR 2.51 [0.89, 7.03] | 3 studies · 1806 participants | Low Downgraded: imprecision, indirectness |
Major Bleeding LMWH prophylaxis vs fondaparinux prophylaxis | RR 0.74 [0.45, 1.23] | 3 studies · 2339 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Minor Bleeding LMWH prophylaxis vs fondaparinux prophylaxis | RR 0.83 [0.34, 2.05] | 2 studies · 398 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Thrombocytopenia LMWH prophylaxis vs fondaparinux prophylaxis | RR 0.35 [0.04, 3.3] | 1 study · 282 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Any Pulmonary embolism LMWH prophylaxis vs fondaparinux prophylaxis | RR 3.1 [0.13, 74.64] | 1 study · 116 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Postoperative drain volume LMWH prophylaxis vs fondaparinux prophylaxis | no estimate extracted | 1 study · 116 participants | Low Downgraded: risk of bias, imprecision, indirectness |
LMWH compared with UFH for perioperative thromboprophylaxis in patients with cancer
Population: patients with perioperative thromboprophylaxis in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality LMWH vs UFH | RR 0.89 [0.74, 1.08] | 9 studies · 9938 participants | Moderate |
PE LMWH vs UFH | RR 0.73 [0.34, 1.54] | 13 studies · 5825 participants | Moderate |
DVT (symptomatic) LMWH vs UFH | RR 0.5 [0.2, 1.28] | 8 studies · 3233 participants | Moderate |
Major bleeding LMWH vs UFH | RR 0.85 [0.52, 1.37] | 8 studies · 3533 participants | Moderate |
Wound hematoma LMWH vs UFH | RR 0.68 [0.52, 0.88] | 6 studies · 2442 participants | Moderate Downgraded: risk of bias |
Thrombocytopenia LMWH vs UFH | RR 1.33 [0.59, 3] | 4 studies · 1911 participants | Low Downgraded: risk of bias |
LMWH compared to UFH for perioperative thromboprophylaxis in patients with cancer
Population: patients with perioperative thromboprophylaxis in patients with cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death LMWH vs UFH | RR 0.9 [0.73, 1.1] | 9 studies · 10483 participants | Moderate |
PE LMWH vs UFH | RR 0.59 [0.25, 1.41] | 13 studies · 5900 participants | Moderate |
DVT (symptomatic) LMWH vs UFH | RR 0.73 [0.23, 2.28] | 6 studies · 1015 participants | Moderate |
Major bleeding LMWH vs UFH | RR 0.84 [0.52, 1.36] | 7 studies · 3441 participants | Moderate |
Wound hematoma LMWH vs UFH | RR 0.6 [0.43, 0.84] | 4 studies · 1777 participants | Moderate Downgraded: risk of bias |
Thrombocytopenia LMWH vs UFH | RR 1.18 [0.49, 2.81] | 3 studies · 1280 participants | Low Downgraded: risk of bias |