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This systematic review of the literature discusses the published trials of ICU thromboprophylaxis and suggests strategies to reduce the incidence of this complication in critical care patients. In the usual risk (normal risk of bleeding) critical care admission the combination of anticoagulant and mechanical prophylaxis is suggested. In the high risk (increased bleeding risk) group the authors state, “Sequential prophylaxis, with the use of mechanical devices during an initial high bleeding risk phase followed by anticoagulant prophylaxis should be considered in relevant critical care patients.” In addition, prophylaxis should be reviewed daily and changed if necessary, taking into consideration each patient’s overall clinical status on that particular day. The authors suggest that policies for thromboprophylaxis should be developed by critical care units.