title: Clinical markers of the hypercoagulable state by rotational thrombelastometry in obese patients submitted to bariatric surgery.
abstract: BACKGROUND
  Metabolic and inflammatory disturbances associated with obesity are considered important trigger factors for venous thromboembolism (VTE). Identification of clinical markers indicating a hypercoagulability state could define a group of high-risk patients in the surgical setting. This study aimed to identify these markers using rotational thrombelastometry (ROTEM) analysis, an established method for hemostasis testing that can detect hyperfunctional stages of the clotting process.
  
  
  METHODS
  From June to December 2010, this study investigated 109 consecutive obese patients (28 women and 22 men, mean age 46 years, body mass index 46.6 ± 7 kg/m(2)) with no history of VTE who were candidates for bariatric surgery. Preoperative clinical and metabolic characteristics and ROTEM analysis were recorded. Hypercoagulable risk was defined when patients showed a clot strength (G) of ≥11 dynes/cm(2).
  
  
  RESULTS
  Of the 109 patients, 20 (18%) were hypercoagulable according to ROTEM analysis. Metabolic/inflammatory biomarkers such as leptin, C-reactive protein, fibrinogen levels, and platelet count were significantly higher in the high-risk patients. In the multivariate analysis, fibrinogen was an independent predictor of G ≥ 11 dynes/cm(2) [odds ratio (OR) 2.92, 95 % confidence interval (CI) 1.80-5.21, p = 0.023]. After adjustment to other data, only waist circumference affected the prediction [OR 4.42, 95 % CI 2.27-6.71, p = 0.009]. Receiver operating characteristic curve analysis showed that 3.95 g/l was the best cutoff point for fibrinogen predictability (sensitivity 100 %, specificity 41%).
  
  
  CONCLUSIONS
  A hypercoagulability state in obese patients is associated with central obesity and high fibrinogen levels, which should be considered clinical hallmarks of this state. More aggressive perioperative prophylaxis for VTE should be recommended when these hallmarks are present in obese patients.
authors.affiliation: Department of Anesthesiology, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain, ptaura@clinic.ub.es.
authors.forename: Pilar
authors.initials: P
authors.lastname: Taura
authors.forename: Eva
authors.initials: E
authors.lastname: Rivas
authors.forename: Graciela
authors.initials: G
authors.lastname: Martinez-Palli
authors.forename: Annabel
authors.initials: A
authors.lastname: Blasi
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Holguera
authors.forename: Jaume
authors.initials: J
authors.lastname: Balust
authors.forename: Salvadora
authors.initials: S
authors.lastname: Delgado
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Lacy
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015415:Biomarkers / Q000097:blood*; D001777:Blood Coagulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*; D019851:Thrombophilia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers
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