Effects of Anticoagulants on Experimental Models of Established Chronic Liver Diseases: A Systematic Review and Meta-Analysis

Table 2

The grading of the quality of evidence for each outcome.

Certainty assessment							No. of patients		Effect		Certainty
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Anticoagulant therapies	Control	Relative (95% CI)	Absolute (95% CI)
Survival
4	Randomized trials	Serious^a	Not serious	Not serious	Not serious	None	143/197 (72.6%)	141/193 (73.1%)	RR 1.03 (0.94 to 1.13)	22 more per 1,000 (from 44 fewer to 95 more)	⊕⊕⊕⃝; moderate
Fibrosis evaluations by METAVIR fibrosis score system
3	Randomized trials	Very serious^a	Serious^b	Not serious	Not serious	Publication bias strongly suspected^c	37/61 (60.7%)	59/59 (100.0%)	RR 0.66 (0.47 to 0.94)	340 fewer per 1,000 (from 60 fewer to 530 fewer)	⊕⃝⃝⃝; very low
Collagen deposition
4	Randomized trials	Very serious^d	Very serious^e	Not serious	Not serious	Publication bias strongly suspected^c	142	120	—	MD −4.1 (−12.42, 4.23)	⊕⃝⃝⃝; very low
Portal pressure
3	Randomized trials	Very serious^a	Not serious	Not serious	Not serious	None	93	87	—	MD −1.39 (−2.33, −0.44)	⊕⊕⃝⃝; low
ALT
10	Randomized trials	Serious^f	Very serious^g	Not serious	Not serious	Publication bias strongly suspected^c	217	196	—	MD −82.7 (−107.36, −58.04)	⊕⃝⃝⃝; very low
AST
7	Randomized trials	Serious^d	Very serious^h	Not serious	Not serious	Publication bias strongly suspected^c	141	130	—	MD −186.12 (−254.90, −117.33)	⊕⃝⃝⃝; very low
Total bilirubin
8	Randomized trials	Very serious^d	Very serious^h	Not serious	Not serious	None	146	134	—	MD −0.96 (−1.46, −0.46)	⊕⃝⃝⃝; very low
Albumin
6	Randomized trials	Very serious^a	Very serious^i	Not serious	Not serious	None	98	88	—	MD 0.59 (0.16, 1.10)	⊕⃝⃝⃝; very low
TNF-α
1	Randomized trials	Very serious^a	Very serious^j	Not serious	Not serious	None	24	24	—	MD −169.69 (−257.64, −81.74)	⊕⃝⃝⃝; very low

CI, confidence interval; RR, risk ratio; MD, Mean difference; ALT, alanine aminotransferase; AST, aspartate aminotransferase. Explanations. ^a (1) All articles did not state detailed randomization method and blinding. (2) Due to poor description about experiment design and methods, many items (concealed allocation and selected outcome assessment, etc.) were “unclear.” ^bI² = 71%. ^cSample size of the included studies was small and the funnel plot was asymmetric. ^d (1) All articles did not state a detailed randomization method. (2) Only one study stated blinding. (3) Due to poor description about experiment design and methods, many items (concealed allocation and selected outcome assessment, etc.) were “unclear.” ^eI² = 98%. ^f (1) 40% articles did not state randomization and all articles did not state a detailed method. (2) Only one study stated blinding. (3) Due to poor description about experiment design and methods, many items (concealed allocation and selected outcome assessment, etc.) were “unclear.” ^gI² = 97%. ^hI² = 98%. ⁱI² = 94%. ^jI² = 80%.