Overweight, Obesity, and the Risk of Recurrent Venous Thromboembolism

Abstract

Background: Excess body weight is a risk factor for a first venousthromboembolism.Theimpactofexcessbodyweight on risk of recurrent venous thrombosis is uncertain. Methods: We studied 1107 patients for an average of 46 months after a first unprovoked venous thromboembolism and withdrawal of anticoagulant therapy. Excluded were pregnant patients, those requiring longterm antithrombotic treatment, and those who had a previous or secondary thrombosis, natural coagulation inhibitor deficiency, lupus anticoagulant, or cancer. Our study end point was symptomatic recurrent venous thromboembolism. Results: A total of 168 patients had recurrent venous thromboembolism. Mean (SD) body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was significantly higher among patients with recurrence than among those without recurrence: 28.5 (6.0) vs 26.9 (5.0) (P = .01). The relationship between excess body weight and recurrence was linear; the adjusted hazard ratio for each 1-point increase in BMI was 1.044 (95% confidence interval [CI], 1.013-1.076) (P Ͻ .001). Four years after discontinuation of anticoagulant therapy, the probability of recurrence was 9.3% (95% CI, 6.0%-12.7%) among patients of normal weight and 16.7% (95% CI, 11.0%-22.3%) and 17.5% (95% CI, 13.0%-22.0%) among overweight and obese patients, respectively. Compared with patients of normal weight, the hazard ratio of recurrence adjusted for age, sex, factor V Leiden, prothrombin G20210A mutation, high factor VIII levels, and type of initial venous thromboembolic event was 1.3 (95% CI, 0.9-1.9) (P=.20) among overweight patients and 1.6 (95% CI, 1.1-2.4) (P = .02) among obese individuals. The population attributable risk corresponding to excess body weight was 26.8% (95% CI, 5.3%-48.2%). Conclusion: Excess body weight is a risk factor of recurrent venous thromboembolism.

Dosing of Unfractionated Heparin in Obese Patients with Venous Thromboembolism

“…Furthermore, the relative size of the gap as a percentage of the recommended dose also increased with body weight, thereby magnifying the risk of harm among more severely obese patients, who already face an increased risk of recurrence. 2,12 While a 100-kg patient received, on average, 77% (1380/1800) of the recommended initial continuous infusion, a 175-kg patient received 62% (1965/3150) of the recommended dose.…”

“…This cross-sectional study examined data from a consecutive series of adult inpatients with a body mass index ≥30 kg/m 2 …”

“…1 Because the risk of recurrence increases in proportion to body mass index, individuals who are overweight or obese face nearly double the risk observed in normal-weight patients. 2 To minimize the likelihood of recurrent VTE, aggressive weight-based dosing formulas have been developed to help achieve prompt therapeutic anticoagulation with unfractionated heparin. 3 These formulas assume that (a) exceeding the therapeutic threshold within the first 24 hours after diagnosis lowers the subsequent risk of recurrence, 4,5 and (b) high initial doses of heparin that may produce supratherapeutic partial thromboplastin times in patients with VTE do not appreciably increase the likelihood of bleeding complications.…”

Medical Assessment and Preparation of Patients Undergoing Bariatric Surgery

“…Obesity is a risk factor for venous thromboembolism (Stein, Beemath et al 2005) and can cause recurrent thromboses (Eichinger, Hron et al 2008). Oestrogen therapy is recommended to be stopped a month prior to surgery to avoid this complication (Mechanick, Kushner et al 2009).…”

Assess Obese Patient Readiness to Decrease Weight: A Practical Approach

“…However, not only the mortality increased, also there is increased in morbidity [15,16]. Heart diseases [17][18][19][20][21], stroke [22,23], hypertension [24,25], diabetes mellitus [26][27][28][29], dyslipidemia [30,31], venous thromboembolism (VTE) [32,33], cancer [34][35][36][37], dementia [38], maternal and fetal complications [39][40][41][42], osteoarthritis [43][44][45], and gastroesophageal reflux disease (GERD) [46] are increased with more gain in weight.Obesity is frequently seen in clinical practice by family physicians. Management of obesity is challenging for patient as well as physician.…”