Summary of findings 3. Peripartum/postnatal prophylaxis: UFH versus no treatment.
| Peripartum/postnatal prophylaxis: UFH versus no treatment for venous thromboembolic disease | ||||||
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Population: women with varicose veins before birth, having a caesarean (elective or emergency) or vaginal birth Settings: Israel (1 RCT) Intervention: UFH Comparison: no treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no UFH | Risk with UFH | |||||
| Maternal death | Not reported | |||||
| Symptomatic thromboembolic events (follow‐up: 6 weeks postpartum) |
Study population | RR 0.16 (0.02 to 1.36) | 210 (1 trial) | ⊕⊝⊝⊝ very low 1, 2, 3 | ||
| 53 per 1000 | 0 per 1000 (1 to 72) |
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| Symptomatic PE (follow‐up: 6 weeks postpartum) |
Study population | RR 0.16 (0.01 to 3.34) | 210 (1 trial) | ⊕⊝⊝⊝ very low 1, 2, 3 | ||
| 21 per 1000 | 0 per 1000 (0 to 71) |
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| Symptomatic DVT (follow‐up: 6 weeks postpartum) |
Study population | RR 0.27 (0.03 to 2.55) | 210 (1 trial) | ⊕⊝⊝⊝ very low 1, 2, 3 | ||
| 32 per 1000 | 0 per 1000 (1 to 81) | |||||
| Adverse effects sufficient to stop treatment | Not reported | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; DVT: deep vein thrombosis; PE: pulmonary embolism; RCT: randomised controlled trial; RR: Risk Ratio; UFH: unfractionated heparin; VTE: venous thromboembolism. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Design limitations (‐1): unclear risk of all sources of bias other than attrition (low risk); not downgraded for lack of blinding as objective outcome
2 Imprecision (‐2): wide confidence intervals crossing line of no effect, few events, and small sample size
3 Indirectness (‐1): specific risk factors for VTE of included women limits applicability of findings to all women at increased risk of VTE intrapartum and in the early postnatal period