Retrospective cohort data published in Cureus on November 9, 2026, revealed that 859 intensive care unit admissions at Sultan Qaboos University Hospital in Oman received distinct thromboprophylaxis strategies between January 2021 and June 2022.
Researchers tracked enoxaparin, unfractionated heparin, and no pharmacological prophylaxis to evaluate deep vein thrombosis, pulmonary embolism, and mortality outcomes.
Among the analyzed admissions, 381 patients received low-molecular-weight heparin using enoxaparin, 220 received unfractionated heparin, and 254 received no pharmacological prophylaxis. Clinically detected deep vein thrombosis appeared in 1.3% of admissions, while pulmonary embolism surfaced in 2.0%.
Patient illness severity varied sharply across the three treatment cohorts at the start of the study period. Median day-1 Sequential Organ Failure Assessment scores stood at 8 for the low-molecular-weight heparin group, compared to 14 for unfractionated heparin and 12 for patients given no pharmacological prophylaxis.
Intensive care unit mortality mirrored these baseline disparities, registering at 14.2% for the low-molecular-weight heparin group, 48.6% for unfractionated heparin, and 47.6% for those receiving no pharmacological prophylaxis. Unadjusted odds ratios for death against the low-molecular-weight heparin reference group reached 5.73 for unfractionated heparin and 5.16 for the no-prophylaxis group.
Controlling for comorbidity and day-1 organ dysfunction altered the risk calculations but did not eliminate the mortality gap. The odds ratio for death with unfractionated heparin shifted to 4.94 after full adjustment, while the comparison with the no-prophylaxis group remained confounded because 98% of those patients had documented clinical contraindications.
Residual confounding from unrecorded treatment-limitation decisions and exact treatment timing leaves the mortality associations strictly hypothesis-generating. The investigation was not powered to detect modest differences in clinically detected thrombotic events, leaving the direct causal impact of each prophylaxis strategy on survival open to future evaluation.
