Summary of findings for DOACs vs LMWHs for the treatment of cancer-associated thrombosis
| Outcome . | No. of participants (studies) . | Certainty of the evidence (GRADE) . | RR (95% CI) . | Observed risk with LMWH . | Anticipated absolute effects . | |
|---|---|---|---|---|---|---|
| Risk with DOACs* . | Absolute risk difference . | |||||
| Recurrent VTE | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 0.68 (0.39 to 1.17) | 8.3% | 5.6% | −2.7% (–5.1 to 1.4) |
| Major bleeding | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.36 (0.55 to 3.35) | 3.5% | 4.8% | 1.3% (–1.6 to 8.3) |
| Composite outcome of first recurrent VTE and major bleeding | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 0.86 (0.60 to 1.23) | 11.1% | 9.5% | −1.6% (–4.4 to 2.6) |
| Clinically relevant nonmajor bleeding | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.63 (0.73 to 3.64) | 6.5% | 10.6% | 4.1% (–1.8 to 17.2) |
| All-cause mortality | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 0.96 (0.68 to 1.36) | 25.7% | 24.7% | −1.0% (–8.2 to 9.3) |
| On-treatment analyses | ||||||
| Recurrent VTE (on-treatment) | 2440 (3 RCTs) | ⊕⊕⊕⊕ HIGH | 0.60 (0.38 to 0.95) | 8.1% | 4.9% | −3.2% (–5.0 to −0.4) |
| Major bleeding (on-treatment) | 2440 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.43 (0.46 to 4.45) | 3.2% | 4.6% | 1.4% (–1.7 to 11.0) |
| Clinically relevant nonmajor bleeding (on-treatment) | 2440 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.93 (0.70 to 5.31) | 4.6% | 8.9% | 4.3% (–1.4 to 19.7) |
| Outcome . | No. of participants (studies) . | Certainty of the evidence (GRADE) . | RR (95% CI) . | Observed risk with LMWH . | Anticipated absolute effects . | |
|---|---|---|---|---|---|---|
| Risk with DOACs* . | Absolute risk difference . | |||||
| Recurrent VTE | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 0.68 (0.39 to 1.17) | 8.3% | 5.6% | −2.7% (–5.1 to 1.4) |
| Major bleeding | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.36 (0.55 to 3.35) | 3.5% | 4.8% | 1.3% (–1.6 to 8.3) |
| Composite outcome of first recurrent VTE and major bleeding | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 0.86 (0.60 to 1.23) | 11.1% | 9.5% | −1.6% (–4.4 to 2.6) |
| Clinically relevant nonmajor bleeding | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.63 (0.73 to 3.64) | 6.5% | 10.6% | 4.1% (–1.8 to 17.2) |
| All-cause mortality | 2607 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 0.96 (0.68 to 1.36) | 25.7% | 24.7% | −1.0% (–8.2 to 9.3) |
| On-treatment analyses | ||||||
| Recurrent VTE (on-treatment) | 2440 (3 RCTs) | ⊕⊕⊕⊕ HIGH | 0.60 (0.38 to 0.95) | 8.1% | 4.9% | −3.2% (–5.0 to −0.4) |
| Major bleeding (on-treatment) | 2440 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.43 (0.46 to 4.45) | 3.2% | 4.6% | 1.4% (–1.7 to 11.0) |
| Clinically relevant nonmajor bleeding (on-treatment) | 2440 (3 RCTs) | ⊕⊕⊕◯ MODERATE due to imprecision† | 1.93 (0.70 to 5.31) | 4.6% | 8.9% | 4.3% (–1.4 to 19.7) |
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). RCTs, randomized controlled trials.
The risk in the DOAC group (and its 95% CI) is based on the observed risk in the LMWH group and the relative effect of the intervention (and its 95% CI).
Graded down for imprecision due to a broad 95% CIs with a possible positive and negative effect of DOAC vs LMWH.