Effect of DOACs vs LMWHs on patient-important outcomes at the end of 6- to 10-day prophylaxis
| Outcomes . | No. of participants (studies) followed up . | GRADE certainty in the evidence . | Relative effect (95% CI) . | Anticipated absolute effects . | |
|---|---|---|---|---|---|
| Risk with LMWHs . | Risk difference with any DOACs . | ||||
| Mortality | 19 900 (3 RCTs) | ⊕⊕⊕⊕ High | RR 0.64 (0.21-1.98) | 1 per 1000 | 0 fewer per 1000 (1 fewer to 1 more) |
| PE | 19 895 (3 RCTs) | ⊕⊕⊕◯ Moderate* | RR 1.01 (0.29-3.53) | Study population: 1 per 1000 Moderate: 4 per 1000† | Study population: 0 fewer per 1000 (1 fewer to 3 more) Moderate: 0 fewer per 1000 (3 fewer to 10 more) |
| Symptomatic DVT | 19 900 (3 RCTs) | ⊕⊕⊕◯ Moderate* | RR 1.03 (0.34-3.08) | Study population: 1 per 1000 Moderate: 2 per 1000‡,§ | Study population: 0 fewer per 1000 (1 fewer to 2 more) Moderate: 0 fewer per 1000 (1 fewer to 4 more) |
| Major bleeding | 21 821 (3 RCTs) | ⊕⊕⊕⊕ High | RR 1.70 (1.02-2.82) | Study population: 2 per 1000 Moderate: 12 per 1000|| | Study population: 2 more per 1000 (0 fewer to 4 more) Moderate: 8 more per 1000 (0 fewer to 22 more) |
| Outcomes . | No. of participants (studies) followed up . | GRADE certainty in the evidence . | Relative effect (95% CI) . | Anticipated absolute effects . | |
|---|---|---|---|---|---|
| Risk with LMWHs . | Risk difference with any DOACs . | ||||
| Mortality | 19 900 (3 RCTs) | ⊕⊕⊕⊕ High | RR 0.64 (0.21-1.98) | 1 per 1000 | 0 fewer per 1000 (1 fewer to 1 more) |
| PE | 19 895 (3 RCTs) | ⊕⊕⊕◯ Moderate* | RR 1.01 (0.29-3.53) | Study population: 1 per 1000 Moderate: 4 per 1000† | Study population: 0 fewer per 1000 (1 fewer to 3 more) Moderate: 0 fewer per 1000 (3 fewer to 10 more) |
| Symptomatic DVT | 19 900 (3 RCTs) | ⊕⊕⊕◯ Moderate* | RR 1.03 (0.34-3.08) | Study population: 1 per 1000 Moderate: 2 per 1000‡,§ | Study population: 0 fewer per 1000 (1 fewer to 2 more) Moderate: 0 fewer per 1000 (1 fewer to 4 more) |
| Major bleeding | 21 821 (3 RCTs) | ⊕⊕⊕⊕ High | RR 1.70 (1.02-2.82) | Study population: 2 per 1000 Moderate: 12 per 1000|| | Study population: 2 more per 1000 (0 fewer to 4 more) Moderate: 8 more per 1000 (0 fewer to 22 more) |
RCT, randomized controlled trial; RR, relative risk.
Serious imprecision. The relative estimate of effect is compatible with important harm and important benefit for the intervention that probably crosses the relevant decision threshold.
Guijarro17 reports on the incidence of PE in acutely ill hospitalized medical patients (n = 1 148 301) based on findings from the Spanish National Discharge Database from October 2005 to September 2006 (retrospective database study).
Guijarro17 reports on the incidence of DVT in acutely ill hospitalized medical patients (n = 1 148 301) based on findings from the Spanish National Discharge Database from October 2005 to September 2006 (retrospective database study).
We applied the assumption that ∼20% of symptomatic DVTs are proximal, 80% are distal, and 100% of each is of moderate severity.
Spencer et al11 reported on incidence rates of major bleeding in older adults based on a community-based study (n = 1223) (prospective and retrospective).