title: The efficacy and safety of different anticoagulants on patients with severe sepsis and derangement of coagulation: a protocol for network meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Sepsis is the leading cause of mortality in non-cardiological critically ill patients. There are as many as 20 million cases of sepsis annually worldwide, with a mortality rate of around 35%. It has been reported that the dysregulation of haemostatic system due to the interaction between coagulation system and inflammatory response is a strong predictor of mortality in patients with severe sepsis. In this context, several anticoagulants have been evaluated in recent years. However, the results of these studies were inconsistent and even contradictory. In addition, there is insufficient evidence comparing the efficacy and safety of different anticoagulants. The purpose of our study is to carry out a systematic review and network meta-analysis comparing the efficacy and safety of different anticoagulants for severe sepsis based on existing randomised controlled trials (RCTs) and ranking these anticoagulants for practical consideration.
  
  
  METHODS
  PubMed, EMBASE and Cochrane Library databases will be systematically searched for eligible studies. Randomised controlled trials (RCT) on anticoagulant therapy for severe sepsis with multiple outcome measures will be included. The Cochrane Risk of Bias Tool will be used to assess the quality of included studies. The primary outcomes are mortality and bleeding events. The secondary outcomes include the length of intensive care stay, the length of hospital stay and duration of mechanical ventilation. Direct pairwise meta-analysis (DMA), indirect treatment comparison meta-analysis (ITC) and network meta-analysis (NMA) will be conducted to compare different anticoagulants.
  
  
  BACKGROUND
  Ethical approval is not required given that this is a protocol for a systematic review. The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at a relevant conference.
  
  
  BACKGROUND
  This protocol has been registered in PROSPERO (http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42014013886.
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine & Institute of emergency Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Libing
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine & Institute of emergency Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Shouyin
authors.initials: S
authors.lastname: Jiang
authors.affiliation: The Second Department of Respiration, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Feng
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine & Institute of emergency Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Yuefeng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine & Institute of emergency Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Mao
authors.initials: M
authors.lastname: Zhang
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D014943:Global Health; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic
chemical_list: D000925:Anticoagulants