{
  "abstract": "Objective: Data are limited regarding optimal low molecular weight heparin dosing for venous thromboembolism prophylaxis in heavier critically ill patients. This trial evaluated the feasibility of a weight-based dynamic dosing algorithm.\n\nDesign, setting, participants: Open-label, electronic medical record-embedded randomised feasibility trial. Patients, weighing ≥100 kg who required thromboprophylaxis were eligible. Enoxaparin was commenced with weight-based dosing and anti-Xa level-guided adjustment (target peak anti-Xa level 0.2–0.4 IU/mL) or usual care (40 mg twice daily).\n\nMain outcome measures: The primary outcome was peak anti-Xa level at ‘steady state’ (after ≥3 enoxaparin doses). The feasibility threshold was set at 95% of steady state anti-Xa levels in the intervention group being less than the threshold for therapeutic anticoagulant effect (≤0.6 IU/mL).\n\nResults: Fifty participants (intervention n = 17, control n = 33) received 331 doses of enoxaparin (median of 4 [interquartile range {IQR}: 3–7] doses per participant, and a dose of 50 [IQR: 50–60] mg (intervention) and 40 [IQR: 40-40] mg (control)). Thirty-two ‘steady state’ peak anti-Xa measurements were recorded from 24 patients (12 intervention and 12 control). The proportion of peak anti-Xa levels that were ≤0.6 IU/mL was: 15 of 17 (88%) vs. 15 of 15 (100%). There were fewer peak anti-Xa measurements below the prophylactic range (<0.2 IU/mL) in the intervention group compared with the control group (2 of 17 [12%] vs. 5 of 15 [33%]). Six patients developed venous thrombosis or pulmonary embolism (2 of 17 [12%] vs. 4 of 33 [12%]). Major bleeding occurred in one patient in the intervention group.\n\nConclusions: A weight-based dynamic thromboprophylaxis algorithm was implemented via the electronic medical record but did not meet the predefined feasibility threshold.",
  "abstract_shown": true,
  "affiliations": [
    "University of Melbourne, Melbourne Medical School, Department of Critical Care, Melbourne, Australia",
    "Royal Melbourne Hospital, Intensive Care Unit, Melbourne, Australia",
    "University of Melbourne, Melbourne School of Population and Global Health, Centre of Epidemiology and Biostatistics, Melbourne, Australia",
    "Methods and Implementation Support for Clinical Health Research (MISCH) Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia",
    "University of Melbourne, Melbourne Medical School, Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia",
    "Royal Melbourne Hospital, Clinical Informatics Centre, Melbourne, Australia",
    "Royal Melbourne Hospital, Pharmacy Department, Melbourne, Australia"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Yasmine Ali Abdelhamid"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Fatima Ali"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Amalia Karahalios"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Haustine Patt Panganiban"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Nadine K. Phillips"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Timothy N. Fazio"
    },
    {
      "affs": [
        0,
        1,
        6
      ],
      "name": "Melissa J. Ankravs"
    },
    {
      "affs": [
        1,
        6
      ],
      "name": "Lucy Sharrock"
    },
    {
      "affs": [
        1
      ],
      "name": "Brianna Tascone"
    },
    {
      "affs": [
        1
      ],
      "name": "James R. Anstey"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Christopher M. MacIsaac"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jeffrey J. Presneill"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Adam M. Deane"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/03x519ypsfr2q.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ccrj.2026.100229",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13734887/",
  "id": "03x519ypsfr2q",
  "issns": [
    "1441-2772",
    "2652-9335"
  ],
  "landing_url": "https://doi.org/10.1016/j.ccrj.2026.100229",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2724|Venous Thromboembolism Diagnosis and Management"
    ]
  ],
  "openalex": "W7223847843",
  "pdf_url": "https://www.sciencedirect.com/science/article/pii/S1441277226000682/pdf",
  "pmcid": "PMC13734887",
  "pmid": "42990884",
  "published": "2026-10-27",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/03x519ypsfr2q.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:20:41Z",
      "native_id": "PMC13734887",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.ccrj.2026.100229"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2724|Venous Thromboembolism Diagnosis and Management",
      "subfield": "general"
    }
  ],
  "title": "Personalised approach to venous thromboembolism prophylaxis in heavier critically ill patients (PROSPER): A randomised, parallel-group, electronic medical record (EMR)-embedded feasibility trial",
  "title_text": "Personalised approach to venous thromboembolism prophylaxis in heavier critically ill patients (PROSPER): A randomised, parallel-group, electronic medical record (EMR)-embedded feasibility trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:20:41Z",
  "url": "https://research.draconitic.com/paper/03x519ypsfr2q",
  "venue": "Critical Care and Resuscitation",
  "versions": []
}