Table 2.
GRADE summary of findings for clinically important gastrointestinal bleeding (CIB) for different comparisons of gastrointestinal bleeding prophylaxis
| Comparison | Odds ratio (95% CI) and measurements | Absolute effect estimates (per 1000) | Absolute difference (95% CI) per 1000 | Certainty in effect estimates | Plain text summary | ||
|---|---|---|---|---|---|---|---|
| PPIs v placebo | 0.61 (0.42 to 0.89). 4317 patients in 8 studies |
Low risk | Placebo: 12 | PPIs: 7 | −5 (−7 to −1) | Moderate* | PPIs probably reduce CIB by less than the amount most people would need to choose a PPI |
| Moderate risk | 30 | 19 | −11 (−17 to −3) | Low*† | PPIs may reduce CIB by less than the amount most people would need to choose a PPI | ||
| High risk | 60 | 37 | −23 (−34 to −6) | Moderate† | PPIs probably reduce CIB | ||
| Highest risk | 90 | 57 | −33 (−50 to −9) | Moderate† | PPIs probably reduce CIB | ||
| H2RAs v placebo | 0.46 (0.27 to 0.79). 1242 patients in 14 studies |
Low risk | Placebo: 12 | H2RAs: 6 | −6 (−9 to −2) | Moderate* | H2RAs probably reduce CIB by less than the amount most people would need to choose a H2RA |
| Moderate risk | 30 | 14 | −16 (−22 to −6) | Low*† | H2RAs may reduce CIB by less than the amount most people would need to choose a H2RA | ||
| High risk | 60 | 29 | −31 (−43 to −12) | Moderate† | H2RAs probably reduce CIB | ||
| Highest risk | 90 | 44 | −46 (−64 to −18) | Moderate† | H2RAs probably reduce CIB | ||
| Sucralfate v placebo | 0.76 (0.36 to 1.62). 874 patients in 6 studies |
Low risk | Placebo: 12 | Suc: 9 | −3 (−8 to 7) | Moderate* | Sucralfate probably does not have an important effect |
| Moderate risk | 30 | 23 | −7 (−19 to 18) | Low*† | Sucralfate may not have an important effect | ||
| High risk | 60 | 46 | −14 (−38 to 34) | Low‡ | Sucralfate may not have an important effect | ||
| Highest risk | 90 | 70 | −20 (−56 to 48) | Low‡ | Sucralfate may not have an important effect | ||
| PPIs v H2RAs | 0.58 (0.29 to 1.17). 1010 patients in 5 studies with low risk of bias |
Low risk | H2RAs: 12 | PPIs: 7§ | −5 (−17 to 1) | Low*† | There may be no important difference |
| Moderate risk | 32 | 19§ | −13 (−44 to 3) | Low*† | PPIs may reduce CIB more than H2RAs | ||
| High risk | 62 | 37§ | −25 (−80 to 5) | Moderate† | PPIs probably reduce CIB more than H2RAs | ||
| Highest risk | 94 | 57§ | −37 (−116 to 8) | Moderate† | PPIs probably reduce CIB more than H2RAs | ||
| PPIs v sucralfate | 0.30 (0.05 to 1.92). 211 patients in 2 studies |
Low risk | Suc: 23 | PPIs: 7§ | −16 (−117 to 3) | Very low*‡ | Whether there is an important difference or not is very uncertain |
| Moderate risk | 61 | 19§ | −42 (−260 to 9) | Very low*‡ | Whether there is an important difference or not is very uncertain | ||
| High risk | 113 | 37§ | −76 (−398 to 17) | Low‡ | PPIs may reduce CIB compared with sucralfate | ||
| Highest risk | 168 | 57§ | −111 (−490 to 27) | Low‡ | PPIs may reduce CIB compared with sucralfate | ||
| H2RAs v sucralfate | 0.46 (0.23 to 0.91). 1340 patients in 2 studies with low risk of bias |
Low risk | Suc: 13 | H2RAs: 6¶ | −7 (−20 to −1) | Low*† | There may be no important difference |
| Moderate risk | 30 | 14¶ | −16 (−44 to −1) | Low*† | H2RAs may reduce CIB compared with sucralfate | ||
| High risk | 61 | 29¶ | −32 (−86 to −3) | Moderate† | H2RAs probably reduce CIB compared with sucralfate | ||
| Highest risk | 91 | 44¶ | −47 (−123 to −4) | Moderate† | H2RAs probably reduce CIB compared with sucralfate | ||
PPIs = proton pump inhibitors; H2RAs = histamine-2 receptor antagonists.
*
Rated down due to uncertainty in baseline risk for some risk factors.
†
Rated down for imprecision.
‡
Rated down 2 levels for imprecision.
§
We used the point estimate of absolute effect for PPIs, obtained from PPIs v placebo, to calculate absolute effect for PPIs v H2RAs and PPIs v sucralfate.
¶
We used the point estimate of absolute effect for H2RAs, obtained from H2RAs v placebo, to calculate absolute effect for H2RAs v sucralfate.