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Войти в исследования Preferences for thromboprophylaxis in the intensive care unit: An international survey.
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Heijkoop Èmese Robin Hélène, Keus Frederik, Møller Morten Hylander, Perner Anders, Morgan Matthew, Abdelhadi Adel, Al Shirawi Nehad Nabeel Mohamed, Al-Fares Abdulrahman A, Alshamsi Fayez, Ananthan Prakkash Parangi, Andreasen Anne Sofie, Anstey Matthew H, Arabi Yaseen M, Aslam Tayyba Naz, Attokaran Antony George, Bestle Morten H, Bhadange Neeraj, Blaser Annika Reintam, Brøchner Anne Craveiro, Cronhjort Maria, Dąbrowski Wojciech, Elhoufi Ashraf, Ergan Begum, Ferrer Ricard, Freebairn Ross, Fujii Tomoko, Greco Massimiliano, van Haren Frank M P, Hildebrandt Thomas, Hjortrup Peter Buhl, Ho Kwok M, Jonmarker Sandra, Kruger Peter, Malbrain Manu L N G, Mallat Jihad, Marella Prashanti, Mer Mervyn, Meyhoff Tine Sylvest, Nalos Marek, Nassef Mohamed, Omar Rania, Orde Sam, Ostermann Marlies, Pilcher David, Poulsen Lone Musaeus, Rai Sumeet, Shekar Kiran, Siegemund Martin, Sigurdsson Martin Ingi, Rasmussen Bodil Steen, Troelsen Thomas Tværmose, Krag Mette, Young Paul, Meijer Karina, Eck Ruben Julius
Аннотация
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.