Anticoagulation in the ICU: Balancing prophylaxis and therapy to minimize thrombotic and hemorrhagic risk
Keywords:
ICU anticoagulation, Thrombotic-hemorrhagic risk, Viscoelastic monitoring, Personalized therapyAbstract
Managing anticoagulation in critically ill patients requires a dynamic balance between preventing thrombotic events and minimizing bleeding risk. While low-dose heparin prophylaxis is used in general risk situations, therapeutic anticoagulation is reserved for confirmed cases of thromboembolism or those with significant hypercoagulability markers. The current approach is based on personalized and continuous assessment, using risk scores (Padua, Wells), viscoelastic tests (TEG/ROTEM), and biomarkers (D-dimer) to guide decisions. Mechanical prophylaxis is recommended in patients at high bleeding risk. The future of this clinical practice points toward the integration of personalized algorithms and dynamic monitoring, always complemented by expert clinical judgment.
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Copyright (c) 2026 Richard Marcial Gálvez-Vila, Alejandro Moya-Linares
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