Reduction in Factor VII, Fibrinogen and Plasminogen Activator Inhibitor-1 Activity after Surgical Treatment of Morbid Obesity

Abstract

SummaryThe aim of this study was to determine the effects of the surgical treatment of morbid obesity on some aspects of haemostatic and fibrinolytic function. Measurement of haemostatic and fibrinolytic factors was performed before and again 6 and 12 months after operation in 19 patients suffering from morbid obesity. Surgical treatment resulted in a mean decrease in body weight of 50 kg at 6 months and 64 kg at 12 months. Weight loss was accompanied at 12 months by significant reductions in median (interquartile range) concentrations of serum cholesterol from 5.3 (4.5–6.2) mmol/1 to 3.6 (2.9–4.6) mmol/1; factor VII from 113 (92–145)% of normal to 99 (85–107)%; of fibrinogen from 3.5 (3–9.3) g/1 to 2.8 (2.4–3.8) g/1; and of plasminogen activator inhibitor-1 (PAI-1) activity from 21 (11–30) IU/ml to 6.3 (5–10) IU/ml. The decrease in PAI-1 activity probably accounted for a significant reduction in euglobulin clot lysis time. Tissue plasminogen activator activity was undetectable in most patients pre-operatively but increased slightly after 1 year to 110 (100–204) mIU/ml. There were no significant changes in plasma levels of KCCT, factor VIII, von Willebrand factor antigen, alpha-2-antiplasmin, antithrombin III, protein C antigen, beta thromboglobulin, platelet factor 4, fibrinopeptide A or platelet count. These findings provide support for the hypothesis that the surgical treatment of morbid obesity may have a long-term beneficial effect on mortality from cardiovascular and thromboembolic disease.

Effect of diet-induced energy deficit and body fat reduction on high-sensitive CRP and other inflammatory markers in obese subjects

“…The level of obesity may therefore explain the missing acute reduction in IL-6, fibrinogen and partly hs-CRP, as the present participants were not morbidly obese and had no evidence of metabolic or systemic diseases. However, other studies with similar subject groups have observed significant acute reductions in hs-CRP, 15,[17][18][19][38][39][40] 15,17,39,[41][42][43] and fibrinogen 23,30,[44][45][46] at smaller and similar weight losses (4-20 kg). One explanation could be that the present study was underpowered to detect a significant change in the pro-inflammatory markers after weight reduction.…”

Plasminogen activator inhibitor 1, transforming growth factor-beta1, and BMI are closely associated in human adipose tissue during morbid obesity.

“…In clinical studies, the relationship between PAI-1 levels and fat mass was emphasized because it persists after controlling for the other biological variables of the insulin resistance syndrome (10). Weight loss secondary to calorie restriction or surgery is associated with reduced PAI-1 activity (the changes are related to weight loss rather than reductions in the biological insulin resistance level) (11). Interestingly, waist-to-hip ratio, a reflection of central fat accumulation, has been found in women to be the only independent predictor of circulating PAI-1 activity (12).…”

Bariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes

“…Recent studies have shown that weight loss induced by surgery results in an impressive reduction of insulin resistance (11,21), reduces relevant markers (C-reactive protein, interleukin-6, interleukin-18, and sCD40L) of chronic vascular inflammation (11,(21)(22)(23), and decreases well-established cardiac risk factors that have been shown to be important predictors of cardiovascular morbidity and mortality (26 -30). In addition, surgery improves endothelial dysfunction (24) and reduces key factors responsible for the increased atherothrombotic risk of the morbidly obese patients, such as tissue factor, factor VII, and plasminogen activator inhibitor (PAI)-1 (19,20).…”