thromboplastin and Obesity--Morbid

Prothrombotic and metabolic variables are decreased after obesity surgery, and fibrin clot lysis is increased. It is unknown how fibrinolytic variables are affected, and whether fibrinolytic and metabolic changes predict the enhanced clot lysis. Study aims were to determine fibrinolytic biomarkers before and 6 months after Roux-en-Y gastric bypass (RYGB) and to identify predictors of the RYGB-induced increase in clot lysis. Women (n = 42) and men (n = 18) with obesity underwent RYGB, and factor XIII (FXIII), thrombin activatable fibrinolysis inhibitor (TAFI), plasminogen and plasmin inhibitor (PI) were measured before and 6 months after surgery. Regression analyses identified determinants of the RYGB-induced increase in clot lysis among changes in fibrinogen and in fibrinolytic and metabolic variables. Results showed that after RYGB, FXIII, TAFI, plasminogen and PI were reduced (P < .0005). Reductions in PI (β = -0.59) and fibrinogen (β = -0.35), together with age (β = -0.22) and male sex (β = 0.22), predicted the enhanced clot lysis with the model explaining 56% (P < .0005). Predictors of the reduction in PI were reductions in cholesterol (β = 0.37) and glucose (β = 0.29), together with male sex (β = -0.28), whereas reductions in fibrinogen were predicted by lowering of interleukin-6 (IL-6) (β = 0.32). In conclusion, fibrinolytic variables were reduced 6 months after RYGB. Targeting PI and fibrinogen, by reducing metabolic variables such as glucose, cholesterol and IL-6, has a profibrinolytic effect in obesity.

Topics: Adult; Antifibrinolytic Agents; Biomarkers; Body Mass Index; Carboxypeptidase B2; Female; Fibrin Clot Lysis Time; Fibrinogen; Gastric Bypass; Humans; Male; Obesity, Morbid; Plasminogen; Postoperative Period; Predictive Value of Tests; Preoperative Period; Randomized Controlled Trials as Topic; Regression Analysis; Sex Factors; Thromboplastin; Treatment Outcome

Tissue factor (TF) is the main in vivo initiator of the blood coagulation cascade. Active circulating TF was detected on small, negatively charged membrane vesicles, the so-called microvesicles (MVs), which are released upon cell activation and apoptosis from a variety of cells. Increased coagulation activation was found in morbidly obese patients, and elevated levels of TF-bearing MVs may contribute to the prothrombotic state in these patients.. To determine MV-associated TF activity levels in morbidly obese patients before and after weight loss due to bariatric surgery.. MV-TF activity was measured with a factor Xa generation assay in morbidly obese patients before and 2 years after bariatric surgery. In addition, clinical parameters were determined.. Seventy-four morbidly obese patients (mean age: 42 (±11) years; 61 females) were included in this study. After bariatric surgery, the body mass index decreased from (median, 25-75th percentile) 45.5 (42.3-50.2) to 30.5 (28.0-34.4 kg m(-2); P<0.001), and a significant improvement in metabolic parameters was observed. Preoperative MV-TF activity correlated with C-reactive protein levels (r=0.3; P=0.02). Postoperatively, the mean MV-TF activity decreased significantly from 0.20 pg ml(-1) (0.18-0.47) to 0.02 (0.00-0.28; P<0.01).. We could demonstrate a significant decrease in MV-TF activity after weight loss in morbidly obese patients. Decreased MV-TF activity might contribute to an improved coagulation profile in these patients after weight loss.

Topics: Adult; Austria; Bariatric Surgery; Biomarkers; Blood Coagulation; Body Mass Index; C-Reactive Protein; Cardiovascular Diseases; Down-Regulation; Female; Humans; Longitudinal Studies; Male; Middle Aged; Obesity, Morbid; Postoperative Period; Prospective Studies; Thromboplastin; Treatment Outcome; Weight Loss

In patients with arterial hypertension (AH) accompanied by abdominal obesity (AO) increase in platelets adhesive and aggregation functions was noted in vitro and in vivo. The cause of these disturbances is blood serum and platelets lipid peroxidation activation, increase in synthesis of Willebrand's factor in a vascular wall, and intensification of thromboxane production in platelets. Activation of thromboplastin production is the main cause of increase in blood coagulation in patients with AH and AO.

Topics: Adult; Blood Coagulation; Blood Platelets; Body Mass Index; Female; Humans; Hypertension; Lipid Peroxidation; Male; Malondialdehyde; Obesity, Morbid; Platelet Aggregation; Platelet Count; Thromboplastin; Thromboxanes; von Willebrand Factor

To investigate the tissue factor (TF) pathway in clinical obesity and associated metabolic syndrome.. Thirty-seven morbidly obese patients (4 men; BMI, 48 +/- 7 kg/m(2); range, 42 to 53 kg/m(2)), undergoing elective gastroplasty for the induction of weight loss, were examined for hemostatic, metabolic, and inflammatory parameters at baseline and 14 +/- 5 months postoperatively.. Weight loss significantly reduced circulating plasma TF (314 +/- 181 vs. 235 +/- 113 pg/mL, p = 0.04), coagulation factor VII (130 +/- 22% vs. 113 +/- 19%, p = 0.023), and prothrombin fragment F1.2 (2.4 +/- 3.4 vs. 1.14 +/- 1.1 nM, p = 0.04) and normalized glucose metabolism in 50% of obese patients preoperatively classified as diabetic or of impaired glucose tolerance. The postoperative decrease in plasma TF correlated with the decrease of F1.2 (r = 0.56; p = 0.005), a marker of in vivo thrombin formation. In subgroup analysis stratified by preoperative glucose tolerance, baseline circulating TF (402.6 +/- 141.6 vs. 176.2 +/- 58.2, p < 0.001) and TF decrease after gastroplasty (DeltaTF: 164.7 +/- 51.4 vs. -81 +/- 31 pg/mL, p = 0.02) were significantly higher in obese patients with impaired glucose tolerance than in patients with normal glucose tolerance.. Procoagulant TF is significantly reduced with weight loss and may contribute to a reduction in cardiovascular risk associated with obesity.

Topics: Adult; Blood Glucose; Body Mass Index; C-Reactive Protein; Factor VII; Female; Gastroplasty; Glycated Hemoglobin; Humans; Insulin; Interleukin-6; Leptin; Lipoproteins; Longitudinal Studies; Male; Obesity, Morbid; Prospective Studies; Prothrombin Time; Statistics, Nonparametric; Thromboplastin; Transforming Growth Factor beta; Weight Loss