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Multicenter Study
. 2025 Jun;51(6):1087-1097.
doi: 10.1007/s00134-025-07980-4. Epub 2025 Jun 16.

Anticoagulation management and outcomes in critically ill patients with acute mesenteric ischemia: an international study

Inès Lakbar  1 , Louis Delamarre  2 , Kadri Tamme  3 , Naira Hernandez De La Torre  1 , Joris Pensier  1 , Clément Monet  1 , Joel Starkopf  3 , Mathieu Capdevila  1 , Marc Leone  4 , Audrey De Jong  1 , Annika Reintam Blaser #  3   5 , Samir Jaber #  6   7 ; AMESI network
Collaborators, Affiliations
Multicenter Study

Anticoagulation management and outcomes in critically ill patients with acute mesenteric ischemia: an international study

Inès Lakbar et al. Intensive Care Med. 2025 Jun.

Abstract

Background: Acute mesenteric ischemia (AMI) is associated with low survival rates. It is recommended to start early a full dose of anticoagulation therapy in patients with AMI, regardless of etiology, surgical or procedural perspective, or coagulation status. However, there are no international studies addressing the impact of timing and dose of anticoagulation therapy on outcome in AMI patients hospitalized in the intensive care unit (ICU).

Methods: This international study combined data from 33 ICU centers in 19 countries. The primary outcome was 30-day survival. Secondary outcomes assessed duration of mechanical ventilation, ICU length of stay, occurrence of hemorrhagic complications and 90-day survival. We also identified independent risk factors for 30-day survival.

Results: Among the 370 analyzed patients, 183 received early full-dose anticoagulation therapy and 187 did not. The 30-day survival was 53.5% (n = 98) in patients receiving early full-dose anticoagulation therapy and 41.7% (n = 78) in patients who did not (p = 0.01), with a number needed to treat (NNT) of n = 8. Early full-dose anticoagulation was associated with a longer duration of mechanical ventilation (p = 0.01). No differences were observed in ICU length of stay or hemorrhagic complications. Improved survival persisted in patients receiving early full-dose anticoagulation at 90 day (p = 0.02). We defined four multivariate Cox hazard models for 30-day survival. Only two intervention therapies were associated with survival: early full-dose anticoagulation and revascularization and/or bowel resection.

Conclusion: This study suggests a significant survival benefit of early full-dose anticoagulation in ICU patients with acute mesenteric ischemia and no difference in hemorrhagic complications. Early full-dose anticoagulation and revascularization and/or bowel resection were associated with survival.

Keywords: Anticoagulation timing; Critical care; Management; Mesenteric ischemia.

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Conflict of interest statement

Declarations. Conflicts of interest: ARB is holding a grant from the Estonian Research Council (Grant PRG1255). SJ received consultant fees from Mindray, Fisher-Paykel, Baxter, Fresenius, Medtronic and Drager. AdJ received fees for presentations from Sanofi, Medtronic, Viatris. IL and ML received fees from presentations Viatris. No other potential conflict of interest relevant to this article was reported. SJ is the Editor-in-Chief of Intensive Care Medicine journal. Ethical approval and consent to participate: In the MOSAIC study, each patient included in this study was contacted with a written letter. Patient consent for the use of their anonymized data was considered granted when a positive written response was received in return or if no response was given, according to French law. In the AMESI study, all sites obtained local ethics approval, informed consent was obtained or waived according to local requirements for an observational study. The study was approved by the Montpellier University Hospital ethics committee (Comité Local d’Ethique Recherche, agreement number: 2024-04-036). Consent for publication: Not applicable.

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