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

Èmese Robin Hélène Heijkoop¹, Frederik Keus², Morten Hylander Møller^{3

4}, Anders Perner³, Matthew Morgan⁵, Adel Abdelhadi⁶, Nehad Nabeel Mohamed Al Shirawi⁷, Abdulrahman A Al-Fares^{8

9}, Fayez Alshamsi¹⁰, Prakkash Parangi Ananthan¹¹, Anne Sofie Andreasen¹², Matthew H Anstey¹³, Yaseen M Arabi¹⁴, Tayyba Naz Aslam^{15

16}, Antony George Attokaran¹⁷, Morten H Bestle^{4

18}, Neeraj Bhadange^{19

20}, Annika Reintam Blaser^{21

22}, Anne Craveiro Brøchner²³, Maria Cronhjort²⁴, Wojciech Dąbrowski²⁵, Ashraf Elhoufi²⁶, Begum Ergan²⁷, Ricard Ferrer^{28

29

30}, Ross Freebairn^{31

32}, Tomoko Fujii³³, Massimiliano Greco^{34

35}, Frank M P van Haren^{36

37}, Thomas Hildebrandt³⁸, Peter Buhl Hjortrup³⁹, Kwok M Ho⁴⁰, Sandra Jonmarker^{41

42}, Peter Kruger⁴³, Manu L N G Malbrain²⁵, Jihad Mallat⁴⁴, Prashanti Marella⁴⁵, Mervyn Mer⁴⁶, Tine Sylvest Meyhoff⁴⁷, Marek Nalos⁴⁸, Mohamed Nassef⁴⁹, Rania Omar⁵⁰, Sam Orde^{51

52}, Marlies Ostermann⁵³, David Pilcher⁵⁴, Lone Musaeus Poulsen⁵⁵, Sumeet Rai⁵⁶, Kiran Shekar^{57

58}, Martin Siegemund^{59

60}, Martin Ingi Sigurdsson^{61

62}, Bodil Steen Rasmussen^{63

64}, Thomas Tværmose Troelsen⁶⁵, Mette Krag^{4

66}, Paul Young^{67

68

69

70}, Karina Meijer⁷¹, Ruben Julius Eck⁷²

Affiliations

¹ Department of Hematology and Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Critical Care Research, University Hospital of Wales, Cardiff, UK.
⁶ Saqr Hospital, EHS, Ras Al Khaimah, United Arab Emirates.
⁷ Intensive Care Unit, Al Fujairah Hospital, Emirates Health Services, Fujairah, United Arab Emirates.
⁸ Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait, Kuwait.
⁹ Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Advanced Respiratory and Cardiac Failure, Ministry of Health, Kuwait, Kuwait.
¹⁰ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
¹¹ Department of Critical Care, Bunbury Regional Hospital, Bunbury, Australia.
¹² Department of Intensive Care, Copenhagen University Hospital Herlev, Herlev, Denmark.
¹³ Sir Charles Gairdner Hospital, Nedlands, Australia.
¹⁴ Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health-Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshopitalet, Oslo University Hospital, Oslo, Norway.
¹⁶ Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁷ University of Queensland Rural Clinical School, Rockhampton, Queensland, Australia.
¹⁸ Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark.
¹⁹ Intensive Care Unit, Ipswich Hospital, Ipswich, Queensland, Australia.
²⁰ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
²¹ Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
²² Intensive Care Department, Lucerne Cantonal Hospital, Lucerne, Switzerland.
²³ Department of Anesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark.
²⁴ Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
²⁵ First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
²⁶ Department of Intensive Care, Dubai Hospital, Dubai, United Arab Emirates.
²⁷ Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylu University, Izmir, Turkiye.
²⁸ Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
²⁹ Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
³⁰ Medicine Department, University Autonomous of Barcelona, Spain.
³¹ Intensive Care Services, Hawke's Bay Hospital, Hastings, New Zealand.
³² Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shat Tin, Hong Kong, China.
³³ Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
³⁴ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
³⁵ Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
³⁶ St George Hospital, Sydney, Australia.
³⁷ College of Health and Medicine, Australian National University, Canberra, Australia.
³⁸ Department of Intensive Care, Zealand University Hospital Roskilde, Roskilde, Denmark.
³⁹ Department of Cardiothoracic Anaesthesia and Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
⁴⁰ Fiona Stanley Hospital & University of Western Australia, Murdoch, Western Australia, Australia.
⁴¹ Department of Clinical science and Education, Karolinska Institutet, Sweden.
⁴² Department of Anesthesia and Intensive care, Södersjukhuset, Stockholm, Sweden.
⁴³ Faculty of Medicine, University of Queensland, Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia.
⁴⁴ Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
⁴⁵ Department of Intensive Care, Caboolture Hospital, Caboolture, Queensland, Australia.
⁴⁶ Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴⁷ Department of Anaesthesia and Intensive Care, Lillebaelt Hospital, Kolding, Denmark.
⁴⁸ Department of Anaesthesiology, Perioperative and Intensive Care Medicine, Masaryk Hospital, J. E. Purkinje University, Usti nad Labem, Czechia.
⁴⁹ Al Qassimi Hospital, Emirates Health Service (EHS), Sharjah, United Arab Emirates.
⁵⁰ Ibrahim bin hamad obaid ullah RAK, Ras Al Khaimah, United Arab Emirates.
⁵¹ Department of Intensive Care, Nepean Hospital, Sydney, Australia.
⁵² University of Sydney.
⁵³ Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
⁵⁴ Department of Intensive Care, Alfred Health, Prahran, Victoria, Australia.
⁵⁵ Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.
⁵⁶ Department of Intensive Care Unit, Canberra Health Services, Canberra, Australia.
⁵⁷ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵⁸ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁵⁹ Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland.
⁶⁰ Department of Clinical Research, University of Basel, Basel, Switzerland.
⁶¹ Department of Anaesthesiology and Critical Cate Medicine, University of Icel, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.
⁶² Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
⁶³ Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
⁶⁴ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁶⁵ Department of Intensive Care, Gødstrup Regional Hospital, Herning, Denmark.
⁶⁶ Department of Anaesthesiology, Holbaek Hospital, Holbaek, Denmark.
⁶⁷ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
⁶⁸ Medical Research Institute of New Zealand, Wellington, New Zealand.
⁶⁹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
⁷⁰ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
⁷¹ Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁷² Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 40023811
DOI: 10.1111/aas.70009

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

Èmese Robin Hélène Heijkoop et al. Acta Anaesthesiol Scand. 2025 Apr.

. 2025 Apr;69(4):e70009.

doi: 10.1111/aas.70009.

Authors

Affiliations

¹ Department of Hematology and Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Critical Care Research, University Hospital of Wales, Cardiff, UK.
⁶ Saqr Hospital, EHS, Ras Al Khaimah, United Arab Emirates.
⁷ Intensive Care Unit, Al Fujairah Hospital, Emirates Health Services, Fujairah, United Arab Emirates.
⁸ Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait, Kuwait.
⁹ Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Advanced Respiratory and Cardiac Failure, Ministry of Health, Kuwait, Kuwait.
¹⁰ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
¹¹ Department of Critical Care, Bunbury Regional Hospital, Bunbury, Australia.
¹² Department of Intensive Care, Copenhagen University Hospital Herlev, Herlev, Denmark.
¹³ Sir Charles Gairdner Hospital, Nedlands, Australia.
¹⁴ Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health-Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshopitalet, Oslo University Hospital, Oslo, Norway.
¹⁶ Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁷ University of Queensland Rural Clinical School, Rockhampton, Queensland, Australia.
¹⁸ Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark.
¹⁹ Intensive Care Unit, Ipswich Hospital, Ipswich, Queensland, Australia.
²⁰ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
²¹ Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
²² Intensive Care Department, Lucerne Cantonal Hospital, Lucerne, Switzerland.
²³ Department of Anesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark.
²⁴ Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
²⁵ First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
²⁶ Department of Intensive Care, Dubai Hospital, Dubai, United Arab Emirates.
²⁷ Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylu University, Izmir, Turkiye.
²⁸ Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
²⁹ Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
³⁰ Medicine Department, University Autonomous of Barcelona, Spain.
³¹ Intensive Care Services, Hawke's Bay Hospital, Hastings, New Zealand.
³² Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shat Tin, Hong Kong, China.
³³ Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
³⁴ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
³⁵ Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
³⁶ St George Hospital, Sydney, Australia.
³⁷ College of Health and Medicine, Australian National University, Canberra, Australia.
³⁸ Department of Intensive Care, Zealand University Hospital Roskilde, Roskilde, Denmark.
³⁹ Department of Cardiothoracic Anaesthesia and Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
⁴⁰ Fiona Stanley Hospital & University of Western Australia, Murdoch, Western Australia, Australia.
⁴¹ Department of Clinical science and Education, Karolinska Institutet, Sweden.
⁴² Department of Anesthesia and Intensive care, Södersjukhuset, Stockholm, Sweden.
⁴³ Faculty of Medicine, University of Queensland, Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia.
⁴⁴ Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
⁴⁵ Department of Intensive Care, Caboolture Hospital, Caboolture, Queensland, Australia.
⁴⁶ Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴⁷ Department of Anaesthesia and Intensive Care, Lillebaelt Hospital, Kolding, Denmark.
⁴⁸ Department of Anaesthesiology, Perioperative and Intensive Care Medicine, Masaryk Hospital, J. E. Purkinje University, Usti nad Labem, Czechia.
⁴⁹ Al Qassimi Hospital, Emirates Health Service (EHS), Sharjah, United Arab Emirates.
⁵⁰ Ibrahim bin hamad obaid ullah RAK, Ras Al Khaimah, United Arab Emirates.
⁵¹ Department of Intensive Care, Nepean Hospital, Sydney, Australia.
⁵² University of Sydney.
⁵³ Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
⁵⁴ Department of Intensive Care, Alfred Health, Prahran, Victoria, Australia.
⁵⁵ Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.
⁵⁶ Department of Intensive Care Unit, Canberra Health Services, Canberra, Australia.
⁵⁷ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵⁸ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁵⁹ Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland.
⁶⁰ Department of Clinical Research, University of Basel, Basel, Switzerland.
⁶¹ Department of Anaesthesiology and Critical Cate Medicine, University of Icel, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.
⁶² Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
⁶³ Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
⁶⁴ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁶⁵ Department of Intensive Care, Gødstrup Regional Hospital, Herning, Denmark.
⁶⁶ Department of Anaesthesiology, Holbaek Hospital, Holbaek, Denmark.
⁶⁷ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
⁶⁸ Medical Research Institute of New Zealand, Wellington, New Zealand.
⁶⁹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
⁷⁰ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
⁷¹ Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁷² Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 40023811
DOI: 10.1111/aas.70009

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.

PubMed Disclaimer

References

REFERENCES

1. Cook D, Crowther M, Meade M, et al. Deep venous thrombosis in medical‐surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med. 2005;33(7):1565‐1571.
1. Minet C, Potton L, Bonadona A, et al. Venous thromboembolism in the ICU: Main characteristics, diagnosis and thromboprophylaxis. Crit Care. 2015;19(1):1‐9. doi:10.1186/s13054‐015‐1003‐9
1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: Clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet. 1999;353(9162):1386‐1389.
1. Kahn SR. How I treat postthrombotic syndrome. Blood. 2009;114(21):4624‐4631. doi:10.1182/blood‐2009‐07‐199174
1. Tapson VF, Humbert M. Incidence and prevalence of chronic thromboembolic pulmonary hypertension: from acute to chronic pulmonary embolism. Proc Am Thorac Soc. 2006;3(7):564‐567.

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical