Table 7.
Summary of findings: Heparin versus oral anticoagulation in patients with cancer requiring long-term treatment of venous thromboembolism.
| Patient or population: Patients with long term treatment of patients with VTE Settings: Outpatient Intervention: LMWH Comparison: VKA | |||||
|---|---|---|---|---|---|
| Outcomes | Illustrative comparative risksa (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk VKA |
Corresponding risk LMWH |
||||
|
| |||||
| Death Follow-up, median 6 mo |
164 per 1000 | 158 per 1000 (133–185) | RR 0.96 (0.81–1.13) | 2496 (7 studies) | Moderate |
|
|
|||||
| Recurrent VTE Follow-up: median 6 mo |
Lowb | RR 0.62 (0.46–0.84) | 2727 (8 studies) | Moderate | |
|
| |||||
| 30 per 1000 | 19 per 1000 (14–25) | ||||
|
| |||||
| Moderateb | |||||
|
| |||||
| 80 per 1000 | 50 per 1000 (37–67) | ||||
|
| |||||
| Highb | |||||
|
| |||||
| 200 per 1000 | 124 per 1000 (92–168) | ||||
|
|
|||||
| Major bleeding Follow-up: median 6 mo |
Lowc | RR 0.81 (0.55–1.2) | 2737 (8 studies) | Moderate | |
|
| |||||
| 20 per 1000 | 16 per 1000 (11–24) | ||||
|
| |||||
| Highd | |||||
|
| |||||
| 80 per 1000 | 65 per 1000 (44–96) | ||||
|
|
|||||
| Post-phlebitic syndrome Self-reported leg symptoms and signs Follow-up: median 2 y |
Moderate | RR 0.85 (0.77–0.94) | 100 (1 study) | Low | |
|
| |||||
| 200 per 1000 | 170 per 1000 (154–188) | ||||
CI, Confidence interval; LMWH, low molecular weight heparin; RR, risk ratio; VKA, vitamin K antagonist; VTE, venous thromboembolism; UFH, unfractionated heparin; GRADE, Grading of Recommendations, Assessment, Development and Evaluation.
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).
Low risk of recurrent VTE corresponds to patients without cancer, intermediate risk of recurrent VTE corresponds to patients with local or recently resected cancer, and high risk of recurrent VTE corresponds to patients with locally advanced or distant metastatic cancer
Low risk of bleeding corresponds to the absence of any risk factor for bleeding (i.e., age >75 y; cancer; metastatic disease; chronic renal or hepatic failure; platelet count <80,0000; antiplatelet therapy; history of bleeding without a reversible cause).
High risk of bleeding corresponds to the presence of at least 1 risk factor for bleeding (i.e., age >75 y, cancer, metastatic disease, chronic renal or hepatic failure, platelet count < 800 000, antiplatelet therapy, history of bleeding without a reversible cause)