Abstract Purpose The need for VTE prophylaxis is well accepted in the ICU and supported by a variety of guideline recommendations. Several studies have highlighted poor adherence to these recommendations but it is unknown why this discrepancy exists. The aim of this study is assess the prevalence of pharmacoprophylaxis and characterize the practice of withholding prophylaxis. Materials and Methods Multi-center cross sectional study conducted in adults admitted to a Georgia ICU at participating institutions on March 12, 2014. Data was collected on eligible patients regarding need for and omission of pharmacoprophylaxis. Results 364 patients across 9 institutions were included in the study. Patients had a mean age of 58 years and a median SOFA score of 5. Physical activity was completely bedridden or restricted in 87% of the cohort. 45% of patients were not receiving pharmacoprophylaxis. The most common reasons for withholding prophylaxis were receipt of mechanical prophylaxis, recent surgery or CNS bleed, and thrombocytopenia. Over 16% of the cohort was inappropriately not receiving thromboprophylaxis. Patients with an elevated INR had lower odds of receiving prophylaxis (0.2). Conclusions VTE prophylaxis is commonly omitted in ICU patients and reasons for omission vary. An elevated INR is associated with withholding of pharmacologic prophylaxis.