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.

1st Department of Anaesthesiology and Intensive Therapy Medical University of Lublin Lublin Poland

Adult Intensive Care Services The Prince Charles Hospital Brisbane Queensland Australia

Al Qassimi Hospital Emirates Health Service Sharjah United Arab Emirates

Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Victoria Australia

College of Health and Medicine Australian National University Canberra Australia

Critical Care Institute Cleveland Clinic Abu Dhabi United Arab Emirates

Critical Care Research University Hospital of Wales Cardiff UK

Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark

Department of Anaesthesia and Intensive Care Chinese University of Hong Kong Shat Tin Hong Kong China

Department of Anaesthesia and Intensive Care Copenhagen University Hospital North Zealand Hilleroed Denmark

Department of Anaesthesia and Intensive Care Lillebaelt Hospital Kolding Denmark

Department of Anaesthesiology and Critical Cate Medicine University of Icel Landspitali The National University Hospital of Iceland Reykjavík Iceland

Department of Anaesthesiology and Intensive Care Medicine Division of Emergencies and Critical Care Rikshopitalet Oslo University Hospital Oslo Norway

Department of Anaesthesiology and Intensive Care University of Tartu Tartu Estonia

Department of Anaesthesiology Holbaek Hospital Holbaek Denmark

Department of Anaesthesiology Perioperative and Intensive Care Medicine Masaryk Hospital J E Purkinje University Usti nad Labem Czechia

Department of Anaesthesiology Zealand University Hospital Køge Denmark

Department of Anesthesia and Intensive Care IRCCS Humanitas Research Hospital Milan Italy

Department of Anesthesia and Intensive care Södersjukhuset Stockholm Sweden

Department of Anesthesia Critical Care Medicine and Pain Medicine Al Amiri Hospital Ministry of Health Kuwait Kuwait

Department of Anesthesiology and Intensive Care Kolding Hospital University Hospital of Southern Denmark Denmark

Department of Biomedical Sciences Humanitas University Milan Italy

Department of Cardiothoracic Anaesthesia and Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Clinical Medicine Aalborg University Aalborg Denmark

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Research University of Basel Basel Switzerland

Department of Clinical science and Education Karolinska Institutet Sweden

Department of Clinical Sciences Karolinska Institutet Danderyd Hospital Stockholm Sweden

Department of Critical Care Bunbury Regional Hospital Bunbury Australia

Department of Critical Care King's College London Guy's and St Thomas' Hospital London UK

Department of Critical Care University Medical Center Groningen University of Groningen Groningen The Netherlands

Department of Critical Care University of Melbourne Melbourne Victoria Australia

Department of Hematology and Critical Care University Medical Center Groningen University of Groningen Groningen The Netherlands

Department of Hematology University Medical Center Groningen University of Groningen Groningen The Netherlands

Department of Intensive Care Alfred Health Prahran Victoria Australia

Department of Intensive Care Caboolture Hospital Caboolture Queensland Australia

Department of Intensive Care Copenhagen University Hospital Herlev Herlev Denmark

Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Intensive Care Dubai Hospital Dubai United Arab Emirates

Department of Intensive Care Gødstrup Regional Hospital Herning Denmark

Department of Intensive Care Jikei University Hospital Tokyo Japan

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

Department of Intensive Care Nepean Hospital Sydney Australia

Department of Intensive Care Unit Canberra Health Services Canberra Australia

Department of Intensive Care Zealand University Hospital Roskilde Roskilde Denmark

Department of Internal Medicine College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates

Department of Internal Medicine University Medical Center Groningen University of Groningen Groningen The Netherlands

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

Department of Pulmonary and Critical Care Faculty of Medicine Dokuz Eylu University Izmir Turkiye

Department of Research and Development Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway

Faculty of Medicine The University of Queensland Brisbane Queensland Australia

Faculty of Medicine University of Iceland Reykjavik Iceland

Faculty of Medicine University of Queensland Brisbane Queensland Australia

Faculty of Medicine University of Queensland Intensive Care Unit Princess Alexandra Hospital Brisbane Australia

Fiona Stanley Hospital and University of Western Australia Murdoch Western Australia Australia

Ibrahim bin hamad obaid ullah RAK Ras Al Khaimah United Arab Emirates

Intensive Care Department Lucerne Cantonal Hospital Lucerne Switzerland

Intensive Care Department Vall d'Hebron University Hospital Vall d'Hebron Barcelona Hospital Campus Barcelona Spain

Intensive Care Medicine Department of Acute Care University Hospital Basel Basel Switzerland

Intensive Care Services Hawke's Bay Hospital Hastings New Zealand

Intensive Care Unit Al Fujairah Hospital Emirates Health Services Fujairah United Arab Emirates

Intensive Care Unit Ipswich Hospital Ipswich Queensland Australia

Intensive Care Unit Wellington Hospital Wellington New Zealand

Kuwait Extracorporeal Life Support Program Al Amiri Center for Advanced Respiratory and Cardiac Failure Ministry of Health Kuwait Kuwait

Medical Research Institute of New Zealand Wellington New Zealand

Medicine Department University Autonomous of Barcelona Spain

Saqr Hospital EHS Ras Al Khaimah United Arab Emirates

Shock Organ Dysfunction and Resuscitation Research Group Vall d'Hebron Research Institute Vall d'Hebron University Hospital Vall d'Hebron Barcelona Hospital Campus Barcelona Spain

Sir Charles Gairdner Hospital Nedlands Australia

St George Hospital Sydney Australia

University of Queensland Rural Clinical School Rockhampton Queensland Australia

University of Sydney

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