TABLE 3.
Summary of findings and grading quality of the evidence.
| Outcomes | Estimate of the effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments |
|---|---|---|---|---|
| Heparin overall treatment compared to no treatment | ||||
| All-cause death | HR 0.66 (0.61–0.72) | 27,889 (19 observational studies) | ⊕⊕◯◯ LOWa , b | The evidence suggests overall Heparin treatment reduces all-cause mortality |
| Major Bleeding | OR 0.88 (0.72–1.08) | 12,691 (4 observational studies) | ⊕⊕◯◯ LOWa , c | The evidence suggests that overall Heparin treatment results in little to no difference in major Bleeding |
| Length of Stay | MD 0.98 Days higher (3.87 lower to 5.83 higher) | 1,541 (3 observational studies) | ⊕◯◯◯ VERY LOWa , b , d | Overall Heparin treatment may have little to no effect on Length of Stay but the evidence is very uncertain |
| Heparin prophylactic treatment compared to no treatment | ||||
| All-cause death | HR 0.63 (0.57–0.69) | 16,989 (11 observational studies) | ⊕⊕◯◯ LOWa , b | Prophylactic Heparin treatment may reduce all-cause mortality |
| Major Bleeding | OR 0.81 (0.66–1.00) | 10,793 (4 observational studies) | ⊕⊕◯◯ LOWa , e | Prophylactic Heparin treatment may result in little to no difference in Major Bleeding |
| Length of Stay | MD 2.40 Days lower (3.14 lower to 1.61 lower) | 138 (2 observational studies) | ⊕◯◯◯ VERY LOWa , b , d | Prophylactic Heparin treatment may reduce Length of Stay but the evidence is very uncertain |
| Heparin full dose treatment compared to no treatment | ||||
| All-cause death | HR 0.56 (0.47–0.66) | 6606 (7 observational studies) | ⊕⊕◯◯ LOWa , b | Heparin full dose treatment may reduce all-cause death |
| Major Bleeding | OR 1.55 (0.98–2.44) | 3,789 (2 observational studies) | ⊕⊕◯◯ LOWa , f | The evidence is uncertain and suggests that heparin full dose treatment may not increase major bleeding |
| Heparin full dose compared to prophylactic treatment | ||||
| All-cause death | HR 0.99 (0.82–1.18) | 4,524 (14 observational studies; 2 RCT) | ⊕⊕◯◯ LOWa , b | The evidence suggests that full dose heparin treatment results in little to no difference in all-cause mortality compared to prophylactic dose |
| Major Bleeding | OR 2.01 (1.14–3.53) | 1,183 (3 observational studies; 1 RCT) | ⊕⊕◯◯ LOWa , d | The evidence suggests that full dose heparin treatment may result in an increase in major bleeding compared to prophylactic dose |
| Length of Stay | MD 2.83 days higher (0.42 higher to 5.25 higher) | 692 (2 observational studies; 1 RCT) | ⊕◯◯◯ VERY LOWa , b , d | The evidence is very uncertain about the effect of full dose heparin treatment on length of Stay |
a
Overall serious risk of bias across studies, mainly due to confounding.
b
Unexplained inconsistency.
c
Imprecision due to CI that include potential benefit and harm.
d
Imprecision due to limited sample size.
e
Imprecision due to CI that include non-significance and potential benefit.
f
Imprecision due to large CI that include non-significance and substantial harm.
Summary of findings are presented for heparin overall treatment, prophylactic treatment, and full dose treatment. CI = confidence interval; HR = hazard ration; OR = odds ratio; MD = mean difference; RCT = randomized controlled trial.