Draft recommendation for consideration by the guideline panel

 

We suggest parenteral heparin for patients with cancer who have no other therapeutic or prophylactic indication.
This recommendation places a relatively high value on death and thromboembolic events, and a relatively low value on bleeding by parenteral heparin.
Voting: 70% of panel is agreement with a recommendation (50% weak recommendation) , and 15% against recommendation.

 

Overall quality of evidence across all critical outcomes MODERATE

Make a judgment using the table below. Add an explanation for your judgement.

Factor Decision Explanation
High or moderate quality evidence

Is there high quality evidence?
The higher the quality of evidence, the more likely is a strong recommendation. 		■  Yes
□  No

quality of evidence across all crital outcomes is moderate
Certainty about the balance of benefits versus harms and burdens

Is there certainty about the balance of benefits vs. harms and burdens?
The larger the difference between desirable and undesirable consequences and the higher the certainty about that difference, the more likely is a strong recommendation. The smaller the net benefit and the lower the certainty about the net benefit, the more likely is a conditional (weak) recommendation. 		■  Yes
□  No

Desirable effects much bigger than undesirable effects, but absolute effect is small and the estimates of the effect is imprecise.
Certainty or differences in values

Is there certainty about and similarity of values and preferences?
The smaller the variability of and uncertainty about values and preferences, the more likely is a conditional (weak) recommendation. 		□  Yes
■  No

All patients would accept treatment for anticoagulation therapy given the risk of mortality and the few major bleeding.
Resource implications

Is the expected net benefit worth the resources being consumed?The more resources are consumed (i.e. the higher the costs of an intervention, compared to the alternative being considered, and other costs related to the decision) the more likely is a conditional (weak) recommendation. 		□  Yes
■  No

the cost is not too high.

Frequent “yes” answers will increase the likelihood of a weak recommendation

If consensus is not reached by discussion, this table below allows the panel making a recommendation to record their views (votes) about the recommendation related to a specific interventions, based on their analysis of the available evidence, the benefits and downsides, values and preferences and cost. This assessment is then mapped to the strength of recommendation for the use, or non-use, of each intervention.

Insert the number of votes for the recommendation in each category

GRADE Strong Weak No strength Weak Strong
Assessors view of the balance of desirable and undesirable consequences of the intervention Desirable consequences clearly outweigh undesirable consequences Desirable consequences probably outweigh undesirable consequences Consequences equally balanced or uncertain Undesirable consequences probably outweigh desirable consequences Undesirable consequences clearly outweigh desirable consequences
Recommendation We recommend to do something We suggest to do something No specific recommendation We recommend to not do something We recommend to not do something
We suggest parenteral heparin for patients with cancer who have no other therapeutic or prophylactic indication. 4 10 3 2 1

 

Strength of a recommendation WEAK
We suggest parenteral heparin for patients with cancer who have no other therapeutic or prophylactic indication. (weak recommendation, moderate quality evidence).
 
 

本ファイルは、GRADEの解説のために、GRADEprofiler(ver. 3.6)を使って、相原が個人的に作成した資料集の一部です。
GRADEシステムの使い方(2012.04.06)