PB0426 - Preferences of thromboprophylaxis in the intensive care unit: an international survey

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

�H

Èmese RH Heijkoop

Medical Doctor
Department of hematology, University Medical Center Groningen, University of Groningen, The Netherlands
Groningen, Groningen, Netherlands
FK

Frederik Keus

Medical Doctor
Department of Critical Care, University Medical Center Groningen, University of Groningen, The Netherlands
Groningen, Groningen, Netherlands
MM

Morten H Møller

Medical Doctor
Dept. of Intensive Care, Copenhagen University Hospital – Rigshospitalet and Dept. of Clinical Medicine, University of Copenhagen
Copenhagen, Hovedstaden, Denmark
AP

Anders Perner

Medical Doctor
Department of Intensive Care, Copenhagen University Hospital – Rigshospitalet and Dept. of Clinical Medicine, University of Copenhagen
Copenhagen, Hovedstaden, Denmark
MM

Matthew Morgan

Medical Doctor
Cardiff University School of Medicine, Wales, UK
Cardiff, Wales, United Kingdom
Karina Meijer

MD, PhD, professor
Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Groningen, Groningen, Netherlands
RE

Ruben J Eck

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

Presenting Author(s)

Tessa Elling, MD

PhD-student
Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
Groningen, Groningen, Netherlands

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.

Aims: This survey aims to assess current thromboprophylaxis preferences and willingness to participate in future randomized clinical trial (RCT) on this topic.

Methods: We conducted an international online survey in spring 2023 among ICU physicians, including 16 questions about the expressed 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 respondents 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, 86%) were applied. A total of 36 pharmacological thromboprophylaxis regimens were reported. Use of low-molecular-weight heparin (LMWH) was most common (n = 149, 90%), followed by subcutaneous unfractionated heparin (n = 44, 27%). Seventy-five percent of respondents indicated that they used enoxaparin 40mg (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, 47%). Participants perceived high variation in 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(s): 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, dose, and dosing strategies. Most respondents would be willing to participate in an RCT on thromboprophylaxis.