Clinical significance of preoperative antithrombin activity in patients with nonocclusive mesenteric ischemia

This study aimed to evaluate the association between preoperative antithrombin (AT) activity levels and postoperative outcomes in patients with nonocclusive mesenteric ischemia (NOMI) who underwent emergency surgery.

This study retrospectively analyzed the preoperative AT activity level measurements of 35 patients with NOMI who underwent emergency surgery between January 2012 and December 2025. The primary outcome was 30-day postoperative mortality. Receiver operating characteristic analysis determined the optimal AT activity level cutoff, and the outcomes were compared between patients with a preoperative AT activity level of <75% and those with a preoperative AT activity level of ≥75%, with further stratification by preoperative Sequential Organ Failure Assessment (SOFA) score.

Preoperative AT activity level was significantly lower in 30-day postoperative nonsurvivors than survivors (54% vs 77%, respectively; P =.009). A preoperative AT activity level of <75% was associated with higher rates of postoperative disseminated intravascular coagulation, greater organ dysfunction, and increased 30-day and in-hospital mortality. The prognostic value was most evident in patients with SOFA scores of <10. All patients with SOFA scores ≥10 had AT activity levels of <75% and poor outcomes.

Lower preoperative AT activity level may be associated with 30-day postoperative mortality in NOMI. Preoperative AT activity level measurement may help facilitate early risk stratification before the development of advanced multiorgan dysfunction.