Preferences for thromboprophylaxis in the intensive care unit: An international survey
Copyright policy )Preferences for thromboprophylaxis in the intensive care unit: An international survey
AbstractBackgroundVenous 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.ObjectiveThis survey aims to assess current thromboprophylaxis preferences and willingness to participate in future randomized clinical trials (RCTs) on this topic.MethodWe 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.ResultsA 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.ConclusionLMWH 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 commentThis 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.
- The Jikei University Hospital Japan
- Karolinska Institute Sweden
- University of Queensland Australia
- University Medical Center Groningen Netherlands
- Monash University Australia
Male, Internationality, Critical Care, Other subheadings::Other subheadings::/therapeutic use, Critical Illness, Otros calificadores::Otros calificadores::/uso terapéutico, Guidelines, Critically-Ill Patients, Enquestes, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::recopilación de datos::encuestas y cuestionarios, Physicians, Surveys and Questionnaires, Tromboembolisme - Tractament, COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::anticoagulantes, Prevalence, CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants, Humans, survey, Other subheadings::Other subheadings::Other subheadings::/prevention & control, Enoxaparin, Practice Patterns, Physicians', Unitats de cures intensives, Otros calificadores::Otros calificadores::Otros calificadores::/prevención & control, COMPUESTOS QUÍMICOS Y DROGAS::hidratos de carbono::polisacáridos::glicosaminoglicanos::heparina::heparina de bajo peso molecular, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and Questionnaires, Critical Care/methods, Anticoagulants, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Venous Thromboembolism/prevention & control, DISEASES::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thromboembolism::Venous Thromboembolism, ENFERMEDADES::enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::tromboembolia::tromboembolia venosa, Intensive Care Units, CHEMICALS AND DRUGS::Carbohydrates::Polysaccharides::Glycosaminoglycans::Heparin::Heparin, Low-Molecular-Weight, ATENCIÓN DE SALUD::instalaciones, servicios y personal de asistencia sanitaria::centros sanitarios::unidades hospitalarias::unidades de cuidados intensivos, Venous Thromboembolism Prophylaxis, Anticoagulants/therapeutic use, Heparin, Low-Molecular-Weight/therapeutic use, ICU, Pulmonary-Embolism, Anticoagulants (Medicina), Tromboembolisme - Prevenció, Heparina - Ús terapèutic, Female, 2703 Anesthesiology and Pain Medicine, thromboprophylaxis, HEALTH CARE::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units
Male, Internationality, Critical Care, Other subheadings::Other subheadings::/therapeutic use, Critical Illness, Otros calificadores::Otros calificadores::/uso terapéutico, Guidelines, Critically-Ill Patients, Enquestes, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::recopilación de datos::encuestas y cuestionarios, Physicians, Surveys and Questionnaires, Tromboembolisme - Tractament, COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::anticoagulantes, Prevalence, CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants, Humans, survey, Other subheadings::Other subheadings::Other subheadings::/prevention & control, Enoxaparin, Practice Patterns, Physicians', Unitats de cures intensives, Otros calificadores::Otros calificadores::Otros calificadores::/prevención & control, COMPUESTOS QUÍMICOS Y DROGAS::hidratos de carbono::polisacáridos::glicosaminoglicanos::heparina::heparina de bajo peso molecular, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and Questionnaires, Critical Care/methods, Anticoagulants, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Venous Thromboembolism/prevention & control, DISEASES::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thromboembolism::Venous Thromboembolism, ENFERMEDADES::enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::tromboembolia::tromboembolia venosa, Intensive Care Units, CHEMICALS AND DRUGS::Carbohydrates::Polysaccharides::Glycosaminoglycans::Heparin::Heparin, Low-Molecular-Weight, ATENCIÓN DE SALUD::instalaciones, servicios y personal de asistencia sanitaria::centros sanitarios::unidades hospitalarias::unidades de cuidados intensivos, Venous Thromboembolism Prophylaxis, Anticoagulants/therapeutic use, Heparin, Low-Molecular-Weight/therapeutic use, ICU, Pulmonary-Embolism, Anticoagulants (Medicina), Tromboembolisme - Prevenció, Heparina - Ús terapèutic, Female, 2703 Anesthesiology and Pain Medicine, thromboprophylaxis, HEALTH CARE::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units
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