Table 15.
—[Section 4.2] Summary of Findings: Should Heparin Compared With No Heparin Be Used for Patients With Cancer Who Have No Other Therapeutic or Prophylactic Indication for Anticoagulation?102
| Outcomes | Illustrative Comparative Risksa (95% CI) |
Relative Effect (95% CI) | No. of Participants (Studies) | Quality of the Evidence (GRADE) | |
| Assumed Risk, No Heparin | Corresponding Risk, Heparin | ||||
| Mortality; follow-up: 12 mo | Medium-risk population | RR, 0.93 (0.85-1.02) | 2,531 (8) | Moderateb -d | |
| 649 per 1,000 | 604 per 1,000 (552 to 662) | ||||
| Symptomatic VTE; follow-up: 12 mo | Medium-risk population | RR, 0.55 (0.37-0.82) | 2,264 (7) | Highb | |
| 29 per 1,000 | 16 per 1,000 (11 to 24) | ||||
| Major bleeding; follow-up: 12 mo | Medium-risk population | RR, 1.3 (0.59-2.88) | 2,843 (9) | Moderateb,e | |
| 7 per 1,000 | 9 per 1,000 (4 to 20) | ||||
| Minor bleeding; follow-up: 12 wk | Medium-risk population | RR, 1.05 (0.75-1.46) | 2,345 (7) | Moderateb,e | |
| 27 per 1,000 | 28 per 1,000 (20 to 39) | ||||
| Health-related quality of life: the Uniscale and the Symptom Distress Scale; better indicated by lower values. Follow-up: 12 mo | Not estimable | Not estimable | Not estimablef | 0 (1) | Lowg |
See Table 4 legend for expansion of abbreviations.
The basis for the assumed risk (eg, the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Vast majority of studies had allocation concealment and used blinded outcome and adjudication. We did not downgrade, although there was some concern about lack of blinding in some studies; the overall risk of bias was believed to be very low.
There is moderate heterogeneity among studies included in the analysis of death at 12 mo (I2 = 41%). The subgroup analysis for mortality at 12 mo was statistically significant and suggested survival benefit in patients with small cell lung cancer but not in patients with advanced cancer. Overall we decided to downgrade by one level when considering these issues along with imprecision.
CI interval includes effects suggesting benefit as well as no benefit.
CI includes possibility of both harms and benefits.
The scores for the two scales were similar for the two study groups, both at baseline and at follow-up.
High risk of bias and only 138 patients enrolled.