Thrombin Generation Measurements in Patients Scheduled for Laparoscopic Bariatric Surgery.

Abstract

Obese patients are known to be in an in vitro hypercoagulable state relative to normal-weight patients. Our study aimed to identify markers of enhanced coagulability (endogenous thrombin potential (ETP)) in morbidly obese patients using the thrombin generation (TG) test. All patients scheduled for laparoscopic bariatric surgery (LBS) between September 1, 2014 and January 31, 2016 were eligible for our prospective study. We used logistic regression to compute the odds ratio (OR) across ETP quartile distributions to evaluate the risk of enhanced TG. We studied 102 patients, 77.5% were female, mean age was 41.2±12.1years, and mean BMI was 45.5±7.0k/m2. Total cholesterol and fibrinogen levels were found to be independent risk factors for patients in the 4th quartile distribution of the ETP distribution (OR (95% CI)) 2.6 (1.2 to 5.4) (P=0.01) and 2.2 (1.1 to 4.5 (P=0.03). Patients in the 4th quartile of the ETP distribution had a lower ETP 1month after surgery (157 (144-196) vs. 120 (98-140); P<0.001) in parallel with a trend toward lower total cholesterol levels (5.0±0.9 vs. 4.4±1.0; P=0.06). Fibrinogen levels were stable (4.5±1.0 vs. 4.4±0.9); P=0.7). Our study highlights the role of total cholesterol and blood inflammatory marker levels in enhancing ETP in morbidly obese patients. Further studies are necessary to confirm the decreased ETP following LBS with the expected reduced inflammatory marker and total cholesterol levels.