Table 2.
Summary of findings table
| Research topic: Direct thrombin inhibitors compared with heparin for extracorporeal membrane oxygenation therapy | ||||||
|---|---|---|---|---|---|---|
|
Patients: Adult and pediatric patients Setting: In-hospital extracorporeal membrane oxygenation therapy Intervention: Direct thrombin inhibitors Comparison: Unfractionated heparin | ||||||
| Outcomes | Illustrative comparative risksb (95% CI) |
Relative effect (95% CI) |
No of Participants (studies) |
Quality of the evidence (GRADE) |
Comments | |
| Assumed riska | Corresponding risk | |||||
| unfractionated heparin | Direct thrombin inhibitors | |||||
| Mortality | 474 per 1000 |
393 per 1000 (346 to 450) |
RR 0.83 (0.73 to 0.95) |
1777 (17) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, publication bias |
|
| Major bleeding events | 501 per 1000 |
336 per 1000 (251 to 456) |
RR 0.67 (0.5 to 0.91) |
1355 (16) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, publication bias |
|
| Minor bleeding events | 287 per 1000 |
247 per 1000 (195 to 316) |
RR 0.86 (0.68 to 1.10) |
632 (8) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, imprecision |
|
| Pump-related thrombosis | 233 per 1000 |
163 per 1000 (121 to 217) |
RR 0.7 (0.52 to 0.93) |
1361 (13) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, imprecision, publication bias |
|
| Patient-related thrombosis | 200 per 1000 |
162 per 1000 (118 to 220) |
RR 0.81 (0.59 to 1.10) |
1447 (15) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, inconsistency, publication bias |
|
|
length of ECMO therapy (hours and days) |
See comment | The SMD in length of ECMO therapy in the intervention groups was 0.12 higher (-0.03 lower to 0.27 higher) |
1274 (12) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, imprecision, publication bias |
Mean for control group not estimable as different measures were used for outcome assessment |
|
|
length of hospital stay (days) |
The mean time to anticoagulation goal ranged across control groups from 5 to 47 days |
The SMD in length of hospital stay in the intervention groups was 0.19 higher (-0.30 lower to 0.69 higher) |
467 (4) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, imprecision, publication bias |
||
|
time to anticoagulation goal (hours) |
The mean time to anticoagulation goal ranged across control groups from 9 to 32 h |
The SMD in time to anticoagulation goal in the intervention groups was 0.2 lower (-0.73 lower to 0.34 higher) |
324 (4) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, imprecision, publication bias |
||
|
Percentage of time within therapeutic range (percentage) |
The mean percentage of time within therapeutic range ranged across control groups from 11 to 31 percent |
The SMD of percentage of time within therapeutic range in the intervention groups was 0.54 higher (0.14 to 0.94 higher) |
491 (5) |
⊕ ⊝ ⊝ ⊝ very low due to lack of RCTs, risk of bias, publication bias |
||
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: 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 quality: We are very uncertain about the estimate
CI Confidence interval, RR Risk Ratio, SMD Standardized mean difference, RCTs randomized controlled trials
aControl group risk estimates come from pooled estimates of control groups
bThe 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)