Table 1.
GRADE Assessments of Certainty of Evidence From Fujisaki et al’s Network Meta-Analysis1
| Comparison | Direct Estimate HR (95% CI) | GRADE Certaintya | Indirect Estimate HR (95% CI) | GRADE Certaintya | NMA Estimate HR (95% CI) | GRADE Certainty | Narrative Summary |
|---|---|---|---|---|---|---|---|
| Recurrent VTE | |||||||
| VKA vs apixaban | 1.80 (0.42-7.69) | High | 2.85 (1.66-4.89) | Moderateb | 2.69 (1.62-4.47) | Moderatec | VKA probably increases the risk of recurrent VTE compared to apixaban. |
| Rivaroxaban vs apixaban | Not applicable | Not applicable | 1.27 (0.66-2.46) | High | 1.27 (0.66-2.46) | Very lowd | There is an uncertain effect of rivaroxaban compared to apixaban on recurrent VTE. |
| Parenteral vs apixaban | 1.75 (1.10-2.77) | High | 1.11 (0.25-4.85) | Moderateb | 1.68 (1.08-2.61) | High | Parenteral anticoagulants increase the risk of recurrent VTE compared to apixaban. |
| Edoxaban vs apixaban | Not applicable | Not applicable | 1.22 (0.68-2.18) | High | 1.22 (0.68-2.18) | Very lowd | There is an uncertain effect of edoxaban compared to apixaban on VTE. |
| Dabigatran vs apixaban | Not applicable | Not applicable | 1.70 (0.48-5.99) | Moderateb | 1.70 (0.48-5.99) | Very lowd | There is an uncertain effect of dabigatran compared to apixaban on recurrent VTE. |
| Major bleeding | |||||||
| VKA vs apixaban | 2.25 (0.39-13.09) | High | 1.68 (0.73-3.85) | High | 1.77 (0.84-3.75) | Very lowd | There is an uncertain effect of VKA compared to apixaban on major bleeding. |
| Rivaroxaban vs apixaban | Not applicable | Not applicable | 1.22 (0.47-3.19) | High | 1.22 (0.47-3.19) | Very lowd | There is an uncertain effect of rivaroxaban compared to apixaban on major bleeding. |
| Parenteral vs apixaban | 1.44 (0.70-2.96) | High | 1.93 (0.32-11.73) | High | 1.50 (0.77-2.92) | Very lowd | There is an uncertain effect of parenteral anticoagulants compared to apixaban on major bleeding. |
| Edoxaban vs apixaban | Not applicable | Not applicable | 2.66 (1.07-6.58) | High | 2.66 (1.07-6.58) | Very lowd | There is an uncertain effect of edoxaban compared to apixaban on major bleeding. |
| Dabigatran vs apixaban | Not applicable | Not applicable | 0.76 (0.12-4.99) | High | 0.76 (0.12-4.99) | Very lowd | There is an uncertain effect of dabigatran compared to apixaban on major bleeding. |
GRADE = Grading of Recommendations, Assessment, Development, and Evaluations; NMA = network meta-analysis; VKA = vitamin K antagonist; VTE = venous thromboembolism.
a
Does not incorporate imprecision (only assessed at the network meta-analysis level).
b
Certainty downrated for inconsistency in comparisons making up the most informative first-order loop.
c
The vast majority of evidence coming from an indirect estimate, which is of moderate certainty.
d
Certainty downrated multiple levels because of extremely serious imprecision with very wide CIs that do not exclude the possibility of important benefit or harm.