Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis

Abstract

BackgroundThe risk of cardiovascular disease is reduced by bariatric surgery, but it is unknown if exercise after bariatric surgery reduces this risk even further. ObjectiveTo investigate if Roux-en-Y-gastric bypass (RYGB) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation, fibrin clot properties, and fibrinolysis. SettingBariatric center, Hospital of Southwest Jutland, Denmark. MethodsSixty obese patients underwent RYGB and 6 months after RYGB were randomized to 26 weeks of physical training or a control group. Biomarkers within coagulation activation, fibrin clot properties, and fibrinolysis were measured presurgery, and 6, 12, and 24 months postsurgery. ResultsSix months after RYGB, the endogenous thrombin potential decreased from 1744 (1603–2003) to 1416 (1276–1582) nM × min (P<.001). Alterations in fibrin clot properties resulted in an increased clot lysis from 23.8% (16.1%–38.9%) to 40.3% (28.5%–59.35; P<.0001). Furthermore, fibrinogen was reduced from 12.6 (11.1–14.7) to 11.5 (9.90–13.3) µM (P<.001), and plasminogen activator inhibitor antigen was reduced from 40.5 (28.4–49.4) to 24.4 (15.4–32.7) ng/mL (P<.0001). Physical training after RYGB increased fibrinolytic activity from 58.0 (36.0–75.5) to 88.0 (66.0–132.0) IU/mL compared with 52.5 (30.0–80.0) to 64.0 (49.0–100.0) IU/mL in controls (P<.01) and reduced plasminogen activator inhibitor antigen from 23.5 (16.7–35.4) to 18.1 (14.3–25.4) ng/mL compared with 24.4 (13.9–28.7) to 24.2 (14.1–29.6) ng/mL in controls (P<.05). No effects of physical training were observed on markers of coagulation activation and fibrin clot properties. ConclusionWe observed favorable long-term reductions in markers of thrombin generation, improved fibrin clot properties, and increases in fibrinolysis after RYGB. Supervised physical training after RYGB further increased fibrinolysis.