Anticoagulants for thrombosis prophylaxis in acutely ill patients admitted to hospital: systematic review and network meta-analysis

Fig 1. Network geometry for each outcome. Network plot is the overview of direct comparisons between interventions. Each circle represents an intervention and is referred to as node. Node size correlates with the number of studies that included the intervention. Lines or edges between nodes represent direct comparisons, and their thickness is proportional to the number of trials contributing to each comparison. The number of trials is also included on the edges. DOAC=direct oral anticoagulant; Int=intermediate dose; low=low dose; LMWH=low-molecular-weight heparin; Pentasach=pentasaccharides; UFH=unfractionated heparin

Fig 2. Head-to-head comparisons of interventions for risk of mortality (upper white fields) and venous thromboembolism (lower shaded fields). Data are odds ratio with 95% credible interval. Figure should be read from left to right: for comparisons of the mortality outcome (upper white fields) odds ratios <1 favour the row defining treatment, whereas for venous thromboembolism (lower shaded fields), odds ratios <1 favour the column defining treatment. For example, LMWH intermediate dose conclusively reduced venous thromboembolism compared with no intervention (odds ratio 0.44; 95% credible interval 0.25 to 0.69), placebo (0.66; 0.46 to 0.93), and UFH low dose (0.63; 0.43 to 0.92), but not to other anticoagulants. To obtain odds ratios for comparisons in the opposite direction, reciprocals should be taken. DOAC=direct oral anticoagulant; int=intermediate dose; LMWH=low-molecular-weight heparin; low=low dose; UFH=unfractionated heparin

Fig 3. Effect estimates of anticoagulants versus placebo or no intervention. Forest plots show effect estimates of each anticoagulant compared with placebo and with no intervention on all four outcomes. Results <1.0 favour the anticoagulant and results >1.0 favour placebo or no intervention. DOAC=direct oral anticoagulant; int=intermediate dose; low=low dose; LMWH=low-molecular-weight heparin; Pentasach=pentasaccharides; UFH=unfractionated heparin

Fig 4. Cumulative ranking curves for all four outcomes. Graphs show the cumulative probability of each intervention ranking, from best (rank 1) to worst (rank 8 or 5 depending on the number of treatments) for each outcome. A rank indicates the probability that an intervention is best, second best, etc. For example, pentasaccharides and intermediate dose LMWH ranked best for preventing venous thromboembolism, whereas no intervention ranked worst. DOAC=direct oral anticoagulant; int=intermediate dose; low=low dose; LMWH=low-molecular-weight heparin; Pentasach=pentasaccharides; UFH=unfractionated heparin. An interactive version of this graphic is available at: https://bit.ly/3nmPgNs

Fig 5. Head-to-head comparisons of interventions for risk of serious adverse events (upper white fields) and major bleeding (lower shaded fields). Data are odds ratio with 95% credible interval. Figure should be read from left to right: for comparisons of the serious adverse event outcome (upper white fields) odds ratios <1 favour the row defining treatment, whereas for major bleeding (lower shaded fields), odds ratios <1 favour the column defining treatment. For example, UFH low dose conclusively increased risk of major bleeding compared with no intervention (odds ratio 2.15; 95% credible interval 1.06 to 5.46), but not to placebo (1.51; 0.68 to 3.86) or other anticoagulants. To obtain odds ratio for comparisons in the opposite direction, reciprocals should be taken. DOAC=direct oral anticoagulant; int=intermediate dose; LMWH=low-molecular-weight heparin; low=low dose; UFH=unfractionated heparin