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    • Preferences for Thromboprophylaxis in the Intensive Care Unit: an International Survey.

    Èmese Robin Hélène Heijkoop,Frederik Keus，Karina Meijer, Ruben Julius Eck

    Acta anaesthesiologica Scandinavica（2025）

    Department of Intensive Care | Critical Care Research | Saqr Hospital | Intensive Care Unit | Department of Critical Care | Sir Charles Gairdner Hospital | University of Queensland Rural Clinical School | Department of Clinical Medicine | Department of Anaesthesiology and Intensive Care | Department of Clinical Sciences | Intensive Care Services | Department of Biomedical Sciences | St George Hospital | Fiona Stanley Hospital & University of Western Australia | Department of Clinical science and Education | Critical Care Institute | Department of Anaesthesia and Intensive Care | Al Qassimi Hospital | Ibrahim bin hamad obaid ullah RAK | Department of Anaesthesiology | Department of Intensive Care Unit | Adult Intensive Care Services | Intensive Care Medicine

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    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.
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    【要点】：该研究通过国际调查发现，重症监护室（ICU）医生在血栓预防治疗上存在较大偏好差异，且大多数医生愿意参与未来关于此主题的随机对照试验（RCT）。
    

    【方法】：研究采用国际在线调查的方式，针对ICU医生的血栓预防治疗偏好以及未来RCT主题的偏好进行了16个问题的问卷调查。
    

    【实验】：共715名来自23个国家170个ICUs的医生参与了调查，平均响应率为36%。结果显示，大部分ICUs同时采用药物（98%）和机械（84%）血栓预防治疗。使用的药物预防方案共有36种，其中低分子肝素（LMWH）使用最为普遍（87%），其次是皮下注射未分级肝素（26%）。75%的医生表示使用每日一次的LMWH（如依诺肝素40mg、达肝素5000IU或替扎肝素4500IU），而25%的医生报告使用其他16种LMWH类型和剂量组合。根据体重调整剂量是常见的做法（46%）。参与者认为血栓预防的应用存在高度变异，并愿意在RCT的背景下考虑更换LMWH类型（76%）或剂量（75%）。