Summary of findings 7. Unfractionated heparin versus no thromboprophylaxis.
| UFH compared withno thromboprophylaxis for primary thromboprophylaxis in ambulatory cancer patients receiving chemotherapy | |||||||
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Patient or population: ambulatory cancer patients receiving chemotherapy Settings: outpatient clinics Intervention: UFH Comparison: no thromboprophylaxis | |||||||
| Outcomes | Relative effect (95% CI) | Illustrative comparative risks* (95% CI) | Differenceb (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | What it means | |
| Assumed riska | Corresponding risk | ||||||
|
With no thromboprophylaxis Number of events per 1000 participants |
With UFH Number of events per 1000 participants |
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Symptomatic VTE Follow‐up: NA |
NAc | Population at unclear riskd | NA | NA | NA | We do not know how UFH affects symptomatic VTE across different cancer types. | |
| NA | NA | ||||||
|
Major bleeding Follow‐up: NA |
NAc | Population at unclear riskd | NA | NA | NA | We do not know how UFH affects major bleeding across different cancer types. | |
| NA | NA | ||||||
|
Symptomatic PE Follow‐up: NA |
NAc | Population at unclear riskd | NA | NA | NA | We do not know how UFH affects symptomatic PE across different cancer types. | |
| NA | NA | ||||||
|
Symptomatic DVT Follow‐up: NA |
NAc | Population at unclear riskd | NA | NA | NA | We do not know how UFH affects symptomatic DVT across different cancer types. | |
| NA | NA | ||||||
|
Any VTE Follow‐up: NA |
NAc | Population at unclear riskd | NA | NA | NA | We do not know how UFH affects any VTE across different cancer types. | |
| NA | NA | ||||||
|
1‐year overall mortality Follow‐up: 1 year |
RR 0.86 (0.72 to 1.03) | Population at unclear riskd | 98 per 1000 fewer events (195 fewer to 21 more) | 277 (1) | ⊕⊕⊕⊝ Moderatee |
UFH probably decreases the incidence of 1‐year overall mortality in small‐cell lung cancer. | |
| 698 per 1000 | 600 per 1000 (502 to 719) | ||||||
|
Clinically relevant bleeding Follow‐up: median not reported, maximum of 4.9 years of follow‐up |
RR 2.01 (0.18 to 21.96) | Population at unclear riskd | 7 per 1000 more events (6 fewer to 151 more) | 277 (1) | ⊕⊕⊝⊝ Lowf |
UFH may increase the risk of clinically relevant bleeding in small‐cell lung cancer. | |
| 7 per 1000 | 14 per 1000 (1 to 158) | ||||||
| *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; NA: not applicable; PE: pulmonary embolism; RR: risk ratio; UFH: unfractionated heparin; VTE: venous thromboembolism. | |||||||
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GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | |||||||
aThe assumed risk was calculated from the observed control group risk in Lebeau 1994. bDifference calculated as the absolute risk difference between the assumed risk and corresponding risk, expressed per 1000. cNo trials contributed to this outcome. dThe risk profile refers to the median observed risk to experience symptomatic VTEs. As Lebeau 1994 did not report this outcome, the risk profile remains unclear. eDowngraded one level because of imprecision. fDowngraded two levels because of imprecision.