title: Bariatric patients have plasmatic hypercoagulability and systemic upregulation of heme oxygenase activity.
abstract: Morbid obesity is associated with significant thrombophilia. Of interest, adipocytes obtained from obese patients have increased heme oxygenase (Hmox) activity, the endogenous enzyme responsible for carbon monoxide (CO) production. Given that CO enhances plasmatic coagulation, we determined whether morbidly obese patients undergoing bariatric surgery had an increase in endogenous CO and plasmatic hypercoagulability. CO was determined by noninvasive pulse oximetry measurement of carboxyhemoglobin (COHb). A thrombelastographic method to assess plasma coagulation kinetics and formation of carboxyhemefibrinogen (COHF) was utilized. Nonsmoking bariatric patients (n = 20, BMI 47 ± 8 kg/m, mean ± SD) had abnormally increased COHb concentrations of 2.7 ± 1.9%, indicative of Hmox upregulation. When coagulation kinetics of these bariatric patients were compared with values obtained from normal individuals' (n = 30) plasma, 70% (95% confidence interval 45.7-88.1%) had abnormally great velocity of clot formation, abnormally large clot strength, and COHF formation. Future investigation of Hmox-derived CO in the pathogenesis of obesity-related thrombophilia is warranted.
authors.affiliation: aDepartment of Anesthesiology bDepartment of Surgery, The University of Arizona College of Medicine, Tucson, Arizona, USA.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Nielsen
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Galvani
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Boyle
authors.forename: Evangelina B
authors.initials: EB
authors.lastname: Steinbrenner
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Matika
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D002248:Carbon Monoxide / Q000097:blood*; D002263:Carboxyhemoglobin / Q000378:metabolism; D005260:Female; D006419:Heme Oxygenase (Decyclizing) / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000201:enzymology / Q000601:surgery; D019851:Thrombophilia / Q000097:blood / Q000209:etiology*; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D002248:Carbon Monoxide; D002263:Carboxyhemoglobin; D006419:Heme Oxygenase (Decyclizing)