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Despite its widespread use, there is insufficient evidence on the optimal dose, and there appears to be practice variation. Determining the LMWH dosing strategy that most effectively balances the risks of venous thromboembolism (VTE) and bleeding may improve outcomes in ICU patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The\n                      <jats:italic>INCEPT\u2010thromboprophylaxis<\/jats:italic>\n                      domain is an investigator\u2010initiated, open\u2010label domain with an integrated feasibility phase on the international, pragmatic, parallel\u2010group, randomised, embedded, multifactorial, adaptive\n                      <jats:italic>Intensive Care Platform Trial (INCEPT)<\/jats:italic>\n                      . Adult acutely admitted ICU patients with an indication for thromboprophylaxis will be randomised to a fixed low dose, a fixed intermediate dose or a weight\u2010adjusted dose of LMWH while in the ICU for a maximum of 90\u2009days. The primary outcome is days alive out of hospital at 30\u2009days. Secondary outcomes include 30\u2010, 90\u2010 and 180\u2010day all\u2010cause mortality; days alive without life support at 30 and 90\u2009days; days alive out of hospital at 90\u2009days; days free of delirium at 30\u2009days; health\u2010related quality of life and cognitive function at 180\u2009days; VTE and major bleeding during hospital stay at 30 and 90\u2009days; and serious adverse reactions at 30 and 90\u2009days. Analyses will primarily be conducted in the intention\u2010to\u2010treat population using Bayesian statistical models with neutral, weakly informative priors. We will assess feasibility after 300 participants and conduct adaptive analyses after follow\u2010up for the primary outcome of 1500 participants and every additional 500 participants to a maximum of 10,000, with adaptive stopping for superiority\/inferiority and practical equivalence (mean difference in the primary outcome &lt;\u20091\u2009day), and adaptive arm\u2010dropping for superiority\/inferiority. Allocation will initially be equal, followed by response\u2010adaptive randomisation with a minimum 25% allocation to each arm. Expected sample sizes across different scenarios range from 2265 to 4892 participants, with approximately 100% probabilities of conclusiveness across scenarios.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      <jats:italic>INCEPT\u2010thromboprophylaxis<\/jats:italic>\n                      will with high probability provide conclusive results and inform clinical practice regarding the dosing of LMWH for thromboprophylaxis in adult acutely admitted ICU patients.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70199","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T08:26:02Z","timestamp":1769761562000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low\u2010Molecular\u2010Weight Heparin for Adult\n                    <scp>ICU<\/scp>\n                    Patients Who Require Thromboprophylaxis: Protocol for the\n                    <scp>INCEPT<\/scp>\n                    \u2010Thromboprophylaxis Platform Trial Domain"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7440-2465","authenticated-orcid":false,"given":"Ruben","family":"Eck","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University Medical Center Groningen, University of Groningen  Groningen the Netherlands"},{"name":"Collaboration for Research in Intensive Care (CRIC)  Copenhagen Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-7655","authenticated-orcid":false,"given":"Anders","family":"Granholm","sequence":"additional","affiliation":[{"name":"Collaboration for Research 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