Preferences for thromboprophylaxis in the intensive care unit: An international survey

Èmese Robin Hélène Heijkoop; Frederik Keus; Morten Hylander Møller; Anders Perner; Matthew Morgan; Adel Abdelhadi; Nehad Nabeel Mohamed al Shirawi; Abdulrahman A. Al-Fares; Fayez Alshamsi; Prakkash Parangi Ananthan; Anne Sofie Andreasen; Matthew H. Anstey; Yaseen M. Arabi; Tayyba Naz Aslam; Antony George Attokaran; Morten H. Bestle; Neeraj Bhadange; Annika Reintam Blaser; Anne Craveiro Brøchner; Maria Cronhjort; Wojciech Dąbrowski; Ashraf Elhoufi; Begum Ergan; Ricard Ferrer; Ross Freebairn; Tomoko Fujii; Massimiliano Greco; Frank M.P. van Haren; Thomas Hildebrandt; Peter Buhl Hjortrup; Kwok M. Ho; Sandra Jonmarker; Peter Kruger; Manu L.N.G. Malbrain; Jihad Mallat; Prashanti Marella; Mervyn Mer; Tine Sylvest Meyhoff; Marek Nalos; Mohamed Nassef; Rania Omar; Sam Orde; Marlies Ostermann; David Pilcher; Lone Musaeus Poulsen; Sumeet Rai; Kiran Shekar; Martin Siegemund; Martin Ingi Sigurdsson; Bodil Steen Rasmussen; Thomas Tværmose Troelsen; Mette Krag; Paul Young; Karina Meijer; Ruben Julius Eck

doi:10.1111/aas.70009

Preferences for thromboprophylaxis in the intensive care unit: An international survey

Èmese Robin Hélène Heijkoop
, Frederik Keus
, Morten Hylander Møller
, Anders Perner
, Matthew Morgan
, Adel Abdelhadi
, Nehad Nabeel Mohamed al Shirawi
, Abdulrahman A. Al-Fares
, Fayez Alshamsi
, Prakkash Parangi Ananthan
, Anne Sofie Andreasen
, Matthew H. Anstey
, Yaseen M. Arabi
, Tayyba Naz Aslam
, Antony George Attokaran
, Morten H. Bestle
, Neeraj Bhadange
, Annika Reintam Blaser
, Anne Craveiro Brøchner
, Maria Cronhjort

Wojciech Dąbrowski, Ashraf Elhoufi, Begum Ergan, Ricard Ferrer, Ross Freebairn, Tomoko Fujii, Massimiliano Greco, Frank M.P. van Haren, Thomas Hildebrandt, Peter Buhl Hjortrup, Kwok M. Ho, Sandra Jonmarker, Peter Kruger, Manu L.N.G. Malbrain, Jihad Mallat, Prashanti Marella, Mervyn Mer, Tine Sylvest Meyhoff, Marek Nalos, Mohamed Nassef, Rania Omar, Sam Orde, Marlies Ostermann, David Pilcher, Lone Musaeus Poulsen, Sumeet Rai, Kiran Shekar, Martin Siegemund, Martin Ingi Sigurdsson, Bodil Steen Rasmussen, Thomas Tværmose Troelsen, Mette Krag, Paul Young, Karina Meijer, Ruben Julius Eck

University of Groningen
University of Copenhagen
University Hospital of Wales
Saqr Hospital
Fujairah Hospital
Al-Amiri Hospital
Ministry of Health, Kuwait
Bunbury Hospital
Sir Charles Gairdner Hospital
King Abdulaziz Medical City - Riyadh
University of Oslo
University of Queensland
Ipswich Hospital
University of Tartu
Kantonsspital Luzern
University of Southern Denmark
Karolinska Institutet
Medical University of Lublin
Dokuz Eylul University
Hospital Universitari Vall d'Hebron
Vall d'Hebron Research Institute
Autonomous University of Barcelona
Hawke’s Bay Hospital
Chinese University of Hong Kong
The Jikei University School of Medicine
Humanitas University
IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
St George Hospital
Australian National University
Sjællands Universitetshospital
University of Western Australia
Caboolture Hospital
University of the Witwatersrand
Jan Evangelista Purkyne University in Usti nad Labem
Ibrahim bin hamad obaid ullah RAK
Nepean Hospital
University of Sydney
Guy's and St Thomas' NHS Foundation Trust
Alfred Health
Canberra Health Services
Queensland Health
University of Basel
University of Iceland
Aalborg University
Gødstrup Hospital
Holbæk Sygehus
Capital & Coast District Health Board
Medical Research Institute of New Zealand
Monash University
Department of Critical Care

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Background: Venous thromboembolism (VTE) is a frequent complication in critically ill patients, who often have multiple risk factors. Pharmacological thromboprophylaxis is widely applied to lower this risk, but guidelines lack dosing recommendations. Objective: This survey aims to assess current thromboprophylaxis preferences and willingness to participate in future randomized clinical trials (RCTs) on this topic. Method: We conducted an international online survey between February and May 2023 among intensive care unit (ICU) physicians, including 16 questions about preferences in relation to thromboprophylaxis and preferences on topics for a future RCT. The survey was distributed through the network of the Collaboration for Research in Intensive Care. Results: A total of 715 physicians from 170 ICUs in 23 countries contributed information, with a mean response rate of 36%. In most ICUs, both pharmacological (n = 166, 98%) and mechanical thromboprophylaxis (n = 143, 84%) were applied. A total of 36 pharmacological thromboprophylaxis regimens were reported. Use of low-molecular-weight heparin (LMWH) was most common (n = 149 ICUs, 87%), followed by subcutaneous unfractionated heparin (n = 44 ICUs, 26%). Seventy-five percent of physicians indicated that they used enoxaparin 40 mg (4000 IU), dalteparin 5000 IU, or tinzaparin 4500 IU once daily, whereas 25% reported the use of 16 other LMWH type and dose combinations. Dose adjustment according to weight was common (78 ICUs, 46%). Participants perceived high variation in the application of thromboprophylaxis and were willing to consider an alternative LMWH type (n = 542, 76%) or dose (n = 538, 75%) in the context of an RCT. Conclusion: LMWH was the preferred agent for thromboprophylaxis in critically ill patients. There was considerable variation in the application of LMWH for prophylaxis, reflected by the use of different types, doses, and dosing strategies. Most physicians would be willing to participate in an RCT on thromboprophylaxis. Editorial comment: This survey demonstrates current patterns in implementation preferences for critically ill patients. While there is one approach and drug that is commonly preferred, these findings show that there is some variation in practice.

Original language	English
Article number	e70009
Journal	Acta Anaesthesiologica Scandinavica
Volume	69
Issue number	4
DOIs	https://doi.org/10.1111/aas.70009
State	Published - Apr 2025

Keywords

ICU
survey
thromboprophylaxis

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10.1111/aas.70009

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Heijkoop, È. R. H., Keus, F., Møller, M. H., Perner, A., Morgan, M., Abdelhadi, A., al Shirawi, N. N. M., Al-Fares, A. A., Alshamsi, F., Ananthan, P. P., Andreasen, A. S., Anstey, M. H., Arabi, Y. M., Aslam, T. N., Attokaran, A. G., Bestle, M. H., Bhadange, N., Blaser, A. R., Brøchner, A. C., ... Eck, R. J. (2025). Preferences for thromboprophylaxis in the intensive care unit: An international survey. Acta Anaesthesiologica Scandinavica, 69(4), Article e70009. https://doi.org/10.1111/aas.70009

@article{8436963e7cf84c74b2bc12d07a2702d2,

title = "Preferences for thromboprophylaxis in the intensive care unit: An international survey",

abstract = "Background: Venous thromboembolism (VTE) is a frequent complication in critically ill patients, who often have multiple risk factors. Pharmacological thromboprophylaxis is widely applied to lower this risk, but guidelines lack dosing recommendations. Objective: This survey aims to assess current thromboprophylaxis preferences and willingness to participate in future randomized clinical trials (RCTs) on this topic. Method: We conducted an international online survey between February and May 2023 among intensive care unit (ICU) physicians, including 16 questions about preferences in relation to thromboprophylaxis and preferences on topics for a future RCT. The survey was distributed through the network of the Collaboration for Research in Intensive Care. Results: A total of 715 physicians from 170 ICUs in 23 countries contributed information, with a mean response rate of 36\%. In most ICUs, both pharmacological (n = 166, 98\%) and mechanical thromboprophylaxis (n = 143, 84\%) were applied. A total of 36 pharmacological thromboprophylaxis regimens were reported. Use of low-molecular-weight heparin (LMWH) was most common (n = 149 ICUs, 87\%), followed by subcutaneous unfractionated heparin (n = 44 ICUs, 26\%). Seventy-five percent of physicians indicated that they used enoxaparin 40 mg (4000 IU), dalteparin 5000 IU, or tinzaparin 4500 IU once daily, whereas 25\% reported the use of 16 other LMWH type and dose combinations. Dose adjustment according to weight was common (78 ICUs, 46\%). Participants perceived high variation in the application of thromboprophylaxis and were willing to consider an alternative LMWH type (n = 542, 76\%) or dose (n = 538, 75\%) in the context of an RCT. Conclusion: LMWH was the preferred agent for thromboprophylaxis in critically ill patients. There was considerable variation in the application of LMWH for prophylaxis, reflected by the use of different types, doses, and dosing strategies. Most physicians would be willing to participate in an RCT on thromboprophylaxis. Editorial comment: This survey demonstrates current patterns in implementation preferences for critically ill patients. While there is one approach and drug that is commonly preferred, these findings show that there is some variation in practice.",

keywords = "ICU, survey, thromboprophylaxis",

author = "Heijkoop, \{{\`E}mese Robin H{\'e}l{\`e}ne\} and Frederik Keus and M{\o}ller, \{Morten Hylander\} and Anders Perner and Matthew Morgan and Adel Abdelhadi and \{al Shirawi\}, \{Nehad Nabeel Mohamed\} and Al-Fares, \{Abdulrahman A.\} and Fayez Alshamsi and Ananthan, \{Prakkash Parangi\} and Andreasen, \{Anne Sofie\} and Anstey, \{Matthew H.\} and Arabi, \{Yaseen M.\} and Aslam, \{Tayyba Naz\} and Attokaran, \{Antony George\} and Bestle, \{Morten H.\} and Neeraj Bhadange and Blaser, \{Annika Reintam\} and Br{\o}chner, \{Anne Craveiro\} and Maria Cronhjort and Wojciech D{\c a}browski and Ashraf Elhoufi and Begum Ergan and Ricard Ferrer and Ross Freebairn and Tomoko Fujii and Massimiliano Greco and \{van Haren\}, \{Frank M.P.\} and Thomas Hildebrandt and Hjortrup, \{Peter Buhl\} and Ho, \{Kwok M.\} and Sandra Jonmarker and Peter Kruger and Malbrain, \{Manu L.N.G.\} and Jihad Mallat and Prashanti Marella and Mervyn Mer and Meyhoff, \{Tine Sylvest\} and Marek Nalos and Mohamed Nassef and Rania Omar and Sam Orde and Marlies Ostermann and David Pilcher and Poulsen, \{Lone Musaeus\} and Sumeet Rai and Kiran Shekar and Martin Siegemund and Sigurdsson, \{Martin Ingi\} and Rasmussen, \{Bodil Steen\} and Troelsen, \{Thomas Tv{\ae}rmose\} and Mette Krag and Paul Young and Karina Meijer and Eck, \{Ruben Julius\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley \& Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.",

year = "2025",

month = apr,

doi = "10.1111/aas.70009",

language = "English",

volume = "69",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Blackwell Munksgaard",

number = "4",

}

Heijkoop, ÈRH, Keus, F, Møller, MH, Perner, A, Morgan, M, Abdelhadi, A, al Shirawi, NNM, Al-Fares, AA, Alshamsi, F, Ananthan, PP, Andreasen, AS, Anstey, MH, Arabi, YM, Aslam, TN, Attokaran, AG, Bestle, MH, Bhadange, N, Blaser, AR, Brøchner, AC, Cronhjort, M, Dąbrowski, W, Elhoufi, A, Ergan, B, Ferrer, R, Freebairn, R, Fujii, T, Greco, M, van Haren, FMP, Hildebrandt, T, Hjortrup, PB, Ho, KM, Jonmarker, S, Kruger, P, Malbrain, MLNG, Mallat, J, Marella, P, Mer, M, Meyhoff, TS, Nalos, M, Nassef, M, Omar, R, Orde, S, Ostermann, M, Pilcher, D, Poulsen, LM, Rai, S, Shekar, K, Siegemund, M, Sigurdsson, MI, Rasmussen, BS, Troelsen, TT, Krag, M, Young, P, Meijer, K & Eck, RJ 2025, 'Preferences for thromboprophylaxis in the intensive care unit: An international survey', Acta Anaesthesiologica Scandinavica, vol. 69, no. 4, e70009. https://doi.org/10.1111/aas.70009

TY - JOUR

T1 - Preferences for thromboprophylaxis in the intensive care unit

T2 - An international survey

AU - Heijkoop, Èmese Robin Hélène

AU - Keus, Frederik

AU - Møller, Morten Hylander

AU - Perner, Anders

AU - Morgan, Matthew

AU - Abdelhadi, Adel

AU - al Shirawi, Nehad Nabeel Mohamed

AU - Al-Fares, Abdulrahman A.

AU - Alshamsi, Fayez

AU - Ananthan, Prakkash Parangi

AU - Andreasen, Anne Sofie

AU - Anstey, Matthew H.

AU - Arabi, Yaseen M.

AU - Aslam, Tayyba Naz

AU - Attokaran, Antony George

AU - Bestle, Morten H.

AU - Bhadange, Neeraj

AU - Blaser, Annika Reintam

AU - Brøchner, Anne Craveiro

AU - Cronhjort, Maria

AU - Dąbrowski, Wojciech

AU - Elhoufi, Ashraf

AU - Ergan, Begum

AU - Ferrer, Ricard

AU - Freebairn, Ross

AU - Fujii, Tomoko

AU - Greco, Massimiliano

AU - van Haren, Frank M.P.

AU - Hildebrandt, Thomas

AU - Hjortrup, Peter Buhl

AU - Ho, Kwok M.

AU - Jonmarker, Sandra

AU - Kruger, Peter

AU - Malbrain, Manu L.N.G.

AU - Mallat, Jihad

AU - Marella, Prashanti

AU - Mer, Mervyn

AU - Meyhoff, Tine Sylvest

AU - Nalos, Marek

AU - Nassef, Mohamed

AU - Omar, Rania

AU - Orde, Sam

AU - Ostermann, Marlies

AU - Pilcher, David

AU - Poulsen, Lone Musaeus

AU - Rai, Sumeet

AU - Shekar, Kiran

AU - Siegemund, Martin

AU - Sigurdsson, Martin Ingi

AU - Rasmussen, Bodil Steen

AU - Troelsen, Thomas Tværmose

AU - Krag, Mette

AU - Young, Paul

AU - Meijer, Karina

AU - Eck, Ruben Julius

PY - 2025/4

Y1 - 2025/4

N2 - Background: Venous thromboembolism (VTE) is a frequent complication in critically ill patients, who often have multiple risk factors. Pharmacological thromboprophylaxis is widely applied to lower this risk, but guidelines lack dosing recommendations. Objective: This survey aims to assess current thromboprophylaxis preferences and willingness to participate in future randomized clinical trials (RCTs) on this topic. Method: We conducted an international online survey between February and May 2023 among intensive care unit (ICU) physicians, including 16 questions about preferences in relation to thromboprophylaxis and preferences on topics for a future RCT. The survey was distributed through the network of the Collaboration for Research in Intensive Care. Results: A total of 715 physicians from 170 ICUs in 23 countries contributed information, with a mean response rate of 36%. In most ICUs, both pharmacological (n = 166, 98%) and mechanical thromboprophylaxis (n = 143, 84%) were applied. A total of 36 pharmacological thromboprophylaxis regimens were reported. Use of low-molecular-weight heparin (LMWH) was most common (n = 149 ICUs, 87%), followed by subcutaneous unfractionated heparin (n = 44 ICUs, 26%). Seventy-five percent of physicians indicated that they used enoxaparin 40 mg (4000 IU), dalteparin 5000 IU, or tinzaparin 4500 IU once daily, whereas 25% reported the use of 16 other LMWH type and dose combinations. Dose adjustment according to weight was common (78 ICUs, 46%). Participants perceived high variation in the application of thromboprophylaxis and were willing to consider an alternative LMWH type (n = 542, 76%) or dose (n = 538, 75%) in the context of an RCT. Conclusion: LMWH was the preferred agent for thromboprophylaxis in critically ill patients. There was considerable variation in the application of LMWH for prophylaxis, reflected by the use of different types, doses, and dosing strategies. Most physicians would be willing to participate in an RCT on thromboprophylaxis. Editorial comment: This survey demonstrates current patterns in implementation preferences for critically ill patients. While there is one approach and drug that is commonly preferred, these findings show that there is some variation in practice.

AB - Background: Venous thromboembolism (VTE) is a frequent complication in critically ill patients, who often have multiple risk factors. Pharmacological thromboprophylaxis is widely applied to lower this risk, but guidelines lack dosing recommendations. Objective: This survey aims to assess current thromboprophylaxis preferences and willingness to participate in future randomized clinical trials (RCTs) on this topic. Method: We conducted an international online survey between February and May 2023 among intensive care unit (ICU) physicians, including 16 questions about preferences in relation to thromboprophylaxis and preferences on topics for a future RCT. The survey was distributed through the network of the Collaboration for Research in Intensive Care. Results: A total of 715 physicians from 170 ICUs in 23 countries contributed information, with a mean response rate of 36%. In most ICUs, both pharmacological (n = 166, 98%) and mechanical thromboprophylaxis (n = 143, 84%) were applied. A total of 36 pharmacological thromboprophylaxis regimens were reported. Use of low-molecular-weight heparin (LMWH) was most common (n = 149 ICUs, 87%), followed by subcutaneous unfractionated heparin (n = 44 ICUs, 26%). Seventy-five percent of physicians indicated that they used enoxaparin 40 mg (4000 IU), dalteparin 5000 IU, or tinzaparin 4500 IU once daily, whereas 25% reported the use of 16 other LMWH type and dose combinations. Dose adjustment according to weight was common (78 ICUs, 46%). Participants perceived high variation in the application of thromboprophylaxis and were willing to consider an alternative LMWH type (n = 542, 76%) or dose (n = 538, 75%) in the context of an RCT. Conclusion: LMWH was the preferred agent for thromboprophylaxis in critically ill patients. There was considerable variation in the application of LMWH for prophylaxis, reflected by the use of different types, doses, and dosing strategies. Most physicians would be willing to participate in an RCT on thromboprophylaxis. Editorial comment: This survey demonstrates current patterns in implementation preferences for critically ill patients. While there is one approach and drug that is commonly preferred, these findings show that there is some variation in practice.

KW - ICU

KW - survey

KW - thromboprophylaxis

UR - https://www.scopus.com/pages/publications/86000200215

U2 - 10.1111/aas.70009

DO - 10.1111/aas.70009

M3 - Article

C2 - 40023811

AN - SCOPUS:86000200215

SN - 0001-5172

VL - 69

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 4

M1 - e70009

ER -

Preferences for thromboprophylaxis in the intensive care unit: An international survey

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