Peer-reviewedCC BY 4.0Critical Care and Resuscitation27 Oct 2026

Personalised approach to venous thromboembolism prophylaxis in heavier critically ill patients (PROSPER): A randomised, parallel-group, electronic medical record (EMR)-embedded feasibility trial

Yasmine Ali Abdelhamid^1,2
Fatima Ali^1,2
Amalia Karahalios^3,4
Haustine Patt Panganiban^1,2
Nadine K. Phillips^3,4
Timothy N. Fazio^5,6
Melissa J. Ankravs^1,2,7
Lucy Sharrock^2,7
Brianna Tascone²
James R. Anstey²
Christopher M. MacIsaac^1,2
Jeffrey J. Presneill^1,2

1 more authors

Adam M. Deane^1,2

7 affiliations

¹University of Melbourne, Melbourne Medical School, Department of Critical Care, Melbourne, Australia
²Royal Melbourne Hospital, Intensive Care Unit, Melbourne, Australia
³University of Melbourne, Melbourne School of Population and Global Health, Centre of Epidemiology and Biostatistics, Melbourne, Australia
⁴Methods and Implementation Support for Clinical Health Research (MISCH) Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
⁵University of Melbourne, Melbourne Medical School, Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
⁶Royal Melbourne Hospital, Clinical Informatics Centre, Melbourne, Australia
⁷Royal Melbourne Hospital, Pharmacy Department, Melbourne, Australia

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.

Design, 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).

Main 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).

Results: 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.

Conclusions: A weight-based dynamic thromboprophylaxis algorithm was implemented via the electronic medical record but did not meet the predefined feasibility threshold.

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BibTeX RIS

BibTeX

@article{abdelhamid2026personalised,
  title = {{Personalised approach to venous thromboembolism prophylaxis in heavier critically ill patients (PROSPER): A randomised, parallel-group, electronic medical record (EMR)-embedded feasibility trial}},
  author = {Yasmine Ali Abdelhamid and Fatima Ali and Amalia Karahalios and Haustine Patt Panganiban and Nadine K. Phillips and Timothy N. Fazio and Melissa J. Ankravs and Lucy Sharrock and Brianna Tascone and James R. Anstey and Christopher M. MacIsaac and Jeffrey J. Presneill and Adam M. Deane},
  journal = {Critical Care and Resuscitation},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ccrj.2026.100229},
  url = {https://doi.org/10.1016/j.ccrj.2026.100229},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Personalised approach to venous thromboembolism prophylaxis in heavier critically ill patients (PROSPER): A randomised, parallel-group, electronic medical record (EMR)-embedded feasibility trial
AU  - Yasmine Ali Abdelhamid
AU  - Fatima Ali
AU  - Amalia Karahalios
AU  - Haustine Patt Panganiban
AU  - Nadine K. Phillips
AU  - Timothy N. Fazio
AU  - Melissa J. Ankravs
AU  - Lucy Sharrock
AU  - Brianna Tascone
AU  - James R. Anstey
AU  - Christopher M. MacIsaac
AU  - Jeffrey J. Presneill
AU  - Adam M. Deane
PY  - 2026
DA  - 2026/10/27
JO  - Critical Care and Resuscitation
DO  - 10.1016/j.ccrj.2026.100229
UR  - https://doi.org/10.1016/j.ccrj.2026.100229
AB  - 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.  Design, 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).  Main 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).  Results: 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.  Conclusions: A weight-based dynamic thromboprophylaxis algorithm was implemented via the electronic medical record but did not meet the predefined feasibility threshold.
SN  - 1441-2772
SN  - 2652-9335
ER  -

Abstract

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