Coagulation Profiles in High BMI and Obesity: A Review of the Prothrombotic State

Abstract

Obesity, defined as a body mass index (BMI) ≥30 kg/m², is a global metabolic disorder strongly associated with an increased risk of arterial and venous thrombosis. This elevated risk is driven by a complex, chronic prothrombotic state characterized by specific alterations in the hemostatic system. This review synthesizes current evidence on the coagulation profile in individuals with high BMI and obesity. Key findings include elevated levels of procoagulant factors (fibrinogen, Factor VIII, von Willebrand factor), a profound suppression of fibrinolysis primarily due to increased plasminogen activator inhibitor-1 (PAI-1), and platelet hyperreactivity. These changes are fueled by chronic low-grade inflammation, endothelial dysfunction, and adipokine dysregulation emanating from dysfunctional visceral adipose tissue. Global viscoelastic tests, such as thromboelastography, consistently demonstrate a hypercoagulable phenotype. The clinical consequences are significant, contributing to a higher incidence of venous thromboembolism, atherothrombotic events, and worse outcomes in conditions like COVID-19. Importantly, substantial weight loss, particularly after bariatric surgery, reverses many of these abnormalities and reduces thrombotic risk. Recognizing this distinct coagulation profile is crucial for optimal thromboprophylaxis and underscores the importance of weight management as a key therapeutic strategy.

Keywords: Obesity, Hypercoagulability, Thrombosis, PAI-1, Fibrinolysis, Visceral Adipose Tissue, Inflammation.

Received Date: February 25, 2024                  

Accepted Date: March 12, 2024                

Published Date: April 17, 2024

Available Online at: https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/523