Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of Thrombophilias in Patients Presenting for Bariatric Surgery

  • Research
  • Clinical
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The rise in bariatric surgery has driven an increased number of complications from venous thromboembolism (VTE). Evidence supports obesity as an independent risk factor for VTE, but the specific derangements underlying the hypercoagulability of obesity are not well defined. To better characterize VTE risk for the purpose of tailoring prophylactic strategies, we developed a protocol for thrombophilia screening in patients presenting for bariatric surgery at our institution.

Methods

Between April 2004 and April 2006, 180 bariatric surgery candidates underwent serologic screening for inherited thrombophilias (Factor V-Leiden mutation, low Protein C activity, low Protein S activity, Free Protein S deficiency) and acquired thrombophilias (D-Dimer elevation, Fibrinogen elevation, elevation of coagulation factors VIII, IX, and XI, elevation of Lupus anticoagulants and homocysteine level, and Antithrombin III deficiency). Prevalence rate of each thrombophilia in the subject group was compared to the actual prevalence rate of the general population.

Results

Most plasma markers of both inherited and acquired thrombophilias were identified in higher than expected proportions, including D-Dimer elevation in 31%, Fibrinogen elevation in 40%, Factor VIII elevation in 50%, Factor IX elevation in 64%, Factor XI elevation in 50%, and Lupus anticoagulant in 13%.

Conclusions

Obesity is a well-described demographic risk factor for VTE. In bariatric surgery candidates routinely screened for serologic markers, both inherited and acquired thrombophilias occurred more frequently than in the general population, and may therefore prove to be useful for individualized VTE risk assessment and prophylaxis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–55.

    Article  CAS  Google Scholar 

  2. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291(23):2847–50.

    Article  CAS  Google Scholar 

  3. Colquitt J, Clegg A, Loveman E, et al. Surgery for morbid obesity. Cochrane Database Syst Rev. 2005;4:CD003641.

    Google Scholar 

  4. Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg. 2002;184(6B):9S–16.

    Article  Google Scholar 

  5. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.

    Article  Google Scholar 

  6. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  Google Scholar 

  7. Shekelle PG, Morton SC, Maglione M, et al. Pharmacological and surgical treatment of obesity. Evid Rep Technol Assess (Summ). 2004;103:1–6.

    Google Scholar 

  8. Nguyen NT, Root J, Zainabadi K, et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg. 2005;140(12):1198–202. discussion 1203.

    Article  Google Scholar 

  9. Goldhaber SZ, Tapson VF. A prospective registry of 5, 451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93(2):259–62.

    Article  Google Scholar 

  10. DeMaria EJ, Carmody BJ. Perioperative management of special populations: obesity. Surg Clin North Am. 2005;85(6):1283–9. xii.

    Article  Google Scholar 

  11. Byrne TK. Complications of surgery for obesity. Surg Clin North Am. 2001;81(5):1181–93. vii-viii.

    Article  CAS  Google Scholar 

  12. Fernandez AZ Jr, Demaria EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239(5):698–702. discussion 702-3.

    Article  Google Scholar 

  13. Farrell TM, Haggerty SP, Overby DW, et al. Clinical application of laparoscopic bariatric surgery: an evidence-based review. Surg Endosc. 2009;23:930–49.

    Article  Google Scholar 

  14. Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.

    Article  Google Scholar 

  15. Melinek J, Livingston E, Cortina G, et al. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Med. 2002;126(9):1091–5.

    PubMed  Google Scholar 

  16. Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160(6):809–15.

    Article  CAS  Google Scholar 

  17. Heit JA, Mohr DN, Silverstein MD, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med. 2000;160(6):761–8.

    Article  CAS  Google Scholar 

  18. Grady D, Wenger NK, Herrington D, et al. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med. 2000;132(9):689–96.

    Article  CAS  Google Scholar 

  19. Alikhan R, Cohen AT, Combe S, et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med. 2004;164(9):963–8.

    Article  Google Scholar 

  20. Coon WW. Risk factors in pulmonary embolism. Surg Gynecol Obstet. 1976;143(3):385–90.

    CAS  PubMed  Google Scholar 

  21. Goldhaber SZ, Savage DD, Garrison RJ, et al. Risk factors for pulmonary embolism. The Framingham Study. Am J Med. 1983;74(6):1023–8.

    Article  CAS  Google Scholar 

  22. Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277(8):642–5.

    Article  CAS  Google Scholar 

  23. Lowe GD, Haverkate F, Thompson SG, et al. Prediction of deep vein thrombosis after elective hip replacement surgery by preoperative clinical and haemostatic variables: the ECAT DVT Study. European Concerted Action on Thrombosis. Thromb Haemost. 1999;81(6):879–86.

    Article  CAS  Google Scholar 

  24. Hansson PO, Eriksson H, Welin L, et al. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: "the study of men born in 1913". Arch Intern Med. 1999;159(16):1886–90.

    Article  CAS  Google Scholar 

  25. White RH, Gettner S, Newman JM, et al. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med. 2000;343(24):1758–64.

    Article  CAS  Google Scholar 

  26. Cushman M, Yanez D, Psaty BM, et al. Association of fibrinogen and coagulation factors VII and VIII with cardiovascular risk factors in the elderly: the Cardiovascular Health Study. Cardiovascular Health Study Investigators. Am J Epidemiol. 1996;143(7):665–76.

    Article  CAS  Google Scholar 

  27. Tsai AW, Cushman M, Rosamond WD, et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med. 2002;162(10):1182–9.

    Article  Google Scholar 

  28. Abdollahi M, Cushman M, Rosendaal FR. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost. 2003;89(3):493–8.

    Article  CAS  Google Scholar 

  29. Di Minno G, Mannucci PM, Tufano A, et al. The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism. J Thromb Haemost. 2005;3(7):1459–66.

    Article  Google Scholar 

  30. Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978–80.

    Article  Google Scholar 

  31. Kucher N, Tapson VF, Goldhaber SZ. Risk factors associated with symptomatic pulmonary embolism in a large cohort of deep vein thrombosis patients. Thromb Haemost. 2005;93(3):494–8.

    Article  CAS  Google Scholar 

  32. Rafail S, Ritis K, Schaefer K, et al. Leptin induces the expression of functional tissue factor in human neutrophils and peripheral blood mononuclear cells through JAK2-dependent mechanisms and TNFalpha involvement. Thromb Res. 2008;122(3):366–75.

    Article  CAS  Google Scholar 

  33. Silva TC, Barrett-Connor E, Ramires JA, et al. Obesity, estrone, and coronary artery disease in postmenopausal women. Maturitas. 2008;59(3):242–8.

    Article  CAS  Google Scholar 

  34. Belanger C, Hould FS, Lebel S, et al. Omental and subcutaneous adipose tissue steroid levels in obese men. Steroids. 2006;71(8):674–82.

    Article  CAS  Google Scholar 

  35. De Lorenzo F, Mukherjee M, Kadziola Z, et al. Association of overall adiposity rather than body mass index with lipids and procoagulant factors. Thromb Haemost. 1998;80(4):603–6.

    PubMed  Google Scholar 

  36. Dandona P, Chaudhuri A, Ghanim H, et al. Proinflammatory effects of glucose and anti-inflammatory effect of insulin: relevance to cardiovascular disease. Am J Cardiol. 2007;99(4A):15B–26.

    Article  CAS  Google Scholar 

  37. Bauer KA. The thrombophilias: well-defined risk factors with uncertain therapeutic implications. Ann Intern Med. 2001;135(5):367–73.

    Article  CAS  Google Scholar 

  38. Overby DW, Kohn GP, Cahan MA, et al. Risk-group targeted inferior vena cava filter placement in gastric bypass patients. Obes Surg. 2009;19(4):451–5.

    Article  Google Scholar 

  39. Buchanan GS, Rodgers GM, Ware Branch D. The inherited thrombophilias: genetics, epidemiology, and laboratory evaluation. Best Pract Res Clin Obstet Gynaecol. 2003;17(3):397–411.

    Article  Google Scholar 

  40. Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158(6):585–93.

    Article  CAS  Google Scholar 

  41. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S–400.

    Article  CAS  Google Scholar 

  42. Heit JA, Silverstein MD, Mohr DN, et al. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med. 1999;159(5):445–53.

    Article  CAS  Google Scholar 

  43. Cotter SA, Cantrell W, Fisher B, et al. Efficacy of venous thromboembolism prophylaxis in morbidly obese patients undergoing gastric bypass surgery. Obes Surg. 2005;15(9):1316–20.

    Article  Google Scholar 

  44. Franco RF, Reitsma PH. Genetic risk factors of venous thrombosis. Hum Genet. 2001;109(4):369–84.

    Article  CAS  Google Scholar 

  45. Bauer KA, Rosendaal FR, Heit JA. Hypercoagulability: too many tests, too much conflicting data. Hematology Am Soc Hematol Educ Program. 2002;2002:353–68.

    Article  Google Scholar 

  46. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9–16.

    PubMed  Google Scholar 

  47. Edmonds MJ, Crichton TJ, Runciman WB, Pradhan M. Evidence-based risk factors for postoperative deep vein thrombosis. ANZ J Surg. 2004;74(12):1082–97.

    Article  Google Scholar 

  48. Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med. 2000;160(22):3415–20.

    Article  CAS  Google Scholar 

  49. Kim V, Spandorfer J. Epidemiology of venous thromboembolic disease. Emerg Med Clin North Am. 2001;19(4):839–59.

    Article  CAS  Google Scholar 

  50. Bick RL, Baker WF. Treatment options for patients who have antiphospholipid syndromes. Hematol Oncol Clin North Am. 2008;22(1):145–53. viii.

    Article  Google Scholar 

  51. Vlachoyiannopoulos PG, Samarkos M, Sikara M, et al. Antiphospholipid antibodies: laboratory and pathogenetic aspects. Crit Rev Clin Lab Sci. 2007;44(3):271–338.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, Campus Box 7081, Chapel Hill, NC, 27599-7081, USA

    D. Wayne Overby, Geoffrey P. Kohn, Mitchell A. Cahan, Karen Colton & Timothy M. Farrell

  2. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joseph A. Galanko & Stephan Moll

Authors
  1. D. Wayne Overby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geoffrey P. Kohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitchell A. Cahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph A. Galanko
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karen Colton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephan Moll
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Timothy M. Farrell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Wayne Overby.

Appendix A

Appendix A

Studies examining the relationship between obesity and venous thromboembolism

Table 4
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Overby, D.W., Kohn, G.P., Cahan, M.A. et al. Prevalence of Thrombophilias in Patients Presenting for Bariatric Surgery. OBES SURG 19, 1278–1285 (2009). https://doi.org/10.1007/s11695-009-9906-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-9906-7

Keywords

Search

Navigation