Download PDF
Thromb Haemost 1992; 68(04): 396-399
DOI: 10.1055/s-0038-1646284
Original Article
Schattauer GmbH Stuttgart

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

J N Primrose
The University Departments of Medicine and Surgery, The General Infirmary, Leeds, UK
,
J A Davies
The University Departments of Medicine and Surgery, The General Infirmary, Leeds, UK
,
C R M Prentice
The University Departments of Medicine and Surgery, The General Infirmary, Leeds, UK
,
R Hughes
The University Departments of Medicine and Surgery, The General Infirmary, Leeds, UK
,
D Johnston
The University Departments of Medicine and Surgery, The General Infirmary, Leeds, UK
› Author Affiliations
Further Information

Publication History

Received 20 September 1991

Accepted after revision 13 May 1992

Publication Date:
04 July 2018 (online)

Also available at
  PDF Download  Permissions and Reprints

Summary

The 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.

 

  • REFERENCES

  • 1 National Institutes of Health Consensus Development Panel on the Health Implications of Obesity Health Implications of Obesity: National Institutes of Health Consensus Development Conference Statement. Ann Intern Med 1985; 103: 1073-1077
    CrossrefPubMedGoogle Scholar
  • 2 Kannel WB. Health and obesity: An overview. In: Health and Obesity.. Kuo PT, Conn HL, De Felice EA. (eds) Raven Press, New York: 1983. pp 01-21
    Google Scholar
  • 3 Van Itallie TB. “Morbid” obesity: a hazardous disorder that resists conservative treatment. Am J Clin Nutr 1980; 33: 358-363
    CrossrefPubMedGoogle Scholar
  • 4 Mason EE. Surgical Treatment of Obesity. WB Saunders. Philadelphia, PA: 1981
    Google Scholar
  • 5 Olsson S-A, Nilsson-Ehle P, Pettersson BG, Sorbris R. Gastroplasty as a treatment for massive obesity: A clinical and biochemical evaluation. Scand J Gastroenterol 1985; 20: 215-221
    CrossrefPubMedGoogle Scholar
  • 6 Gleysteen JJ, Barboriak JJ. Improvement in heart disease risk factors after gastric bypass. Arch Surg 1983; 118: 681-684
    CrossrefPubMedGoogle Scholar
  • 7 Marks HH. Influence of obesity on morbidity and mortality. Bull NY Acad Sci 1960; 36: 296-312
    PubMedGoogle Scholar
  • 8 Baird IM. Obesity and coronary heart disease. Post Grad Med J 1971; 47: 30-32
    CrossrefPubMedGoogle Scholar
  • 9 Lowe GDO, Drummond MM, Lorrimer AR, Hutton I. et al Relation between extent of coronary artery disease and blood viscosity. Br Med J 1980; 280: 673-675
    CrossrefPubMedGoogle Scholar
  • 10 Meade TW, Mellous S, Brozovic M. et al Haemostatic function and ischaemic heart disease – Principal results of the Northwick Part heart study. Lancet 1986; 2: 533-537
    PubMedGoogle Scholar
  • 11 Wilhelmsen L, Svardsudd K, Korsan-Bentsen K, Larsson B. et al Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med 1984; 311: 501-505
    CrossrefPubMedGoogle Scholar
  • 12 Hamsten A, de Faire U, Walldius G, Dahlen G, Szamosi A. et al Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction. Lancet 1987; 2: 3-9
    PubMedGoogle Scholar
  • 13 Hardisty RM, McPherson JC. A one-stage FVIII AHG assay and its use on venous and capillary plasma. Thromb Diath Haemorrh 1962; 7: 215-229
    PubMedGoogle Scholar
  • 14 Laurell C-B. Quantitative estimation of protein by electrophoresis in agarose gel containing antibodies. Anal Biochem 1966; 15: 45-52
    CrossrefPubMedGoogle Scholar
  • 15 Hall R, Malia RG. Assay Techniques. Medical Laboratory Haematology. Butterworths, London: 1984. pp 574-580
    Google Scholar
  • 16 Claus A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol 1957; 17: 237-246
    CrossrefPubMedGoogle Scholar
  • 17 Abildgard U, Lie M, Odegarrd OR. Antithrombin (heparin-cofactor) assay with “new” chromogenic substrates (S2238 and chromozym TH). Thromb Res 1977; 11: 549-553
    CrossrefPubMedGoogle Scholar
  • 18 Bertina RM, Broeckmans AW, van der Linden IK, Mertens K. Protein C deficiency in a Dutch family with thrombotic disease. Thromb Haemostas 1982; 48: 1-5
    PubMedGoogle Scholar
  • 19 Blix S. Studies on the fibrinolytic system in the euglobulin fraction of human plasma. Scan J Clin Lab Invest 1961; 13 (suppl58): 03-19
    PubMedGoogle Scholar
  • 20 Verheijen JH, Mullaart E, Chang GTG, Kluft C, Wijngaards G. A simple, sensitive spectrophotometric assay for extrinsic (tissue-type) plasminogen activator applicable to measurement in plasma. Thromb Haemostas 1982; 48: 266-269
    PubMedGoogle Scholar
  • 21 Verheijen HJ, Chang GTG, Kluft C. Evidence for the occurrence of a fast-acting inhibitor for tPA in human plasma. Thromb Haemostas 1984; 51: 392-395
    PubMedGoogle Scholar
  • 22 Lowe GDO, Osborne DH, McArdle CM, Smith A. et al Prediction and selective prophylaxis of venous thrombosis in elective gastrointestinal surgery. Lancet 1982; 1: 409-412
    PubMedGoogle Scholar
  • 23 Balleisen L, Bailey J, Epping P-H, Schulte H, van de Loo J. Epidemiological study on factor VII, factor VIII and fibrinogen in an industrial population: I. Baseline data on the relation to age, gender, body-weight, smoking, alcohol, pill-using and menopause. Thromb Haemostas 1985; 54: 475-479
    PubMedGoogle Scholar
  • 24 Meade TW, Chakrabarti R, Haines AP, North WRS, Stirling Y. Characteristics affecting fibrinolytic activity and plasma fibrinogen concentrations. Br Med J 1979; 1: 153-156
    CrossrefPubMedGoogle Scholar
  • 25 Sundell IB, Nilsson TK, Hallmans G, Nygren C. The effect of body build, diet and endocrine factors on the extrinsic fibrinolytic system in healthy young women. Scand J Clin Lab Invest 1988; 48: 557-564
    CrossrefPubMedGoogle Scholar
  • 26 Sundell IB, Dahlgren S, Ranby M, Lundin E, Stenling R, Nilsson TK. Reduction of elevated plasminogen activator inhibitor levels during modest weight loss. Fibrinolysis 1989; 3: 51-53
    PubMedGoogle Scholar
  • 27 Anderson P, Nilsen DWT, Beckman SL, Holme I. et al Increased fibrinolytic potential after diet intervention in healthy coronary high risk individuals. Acta Med Scand 1988; 223: 499-506
    PubMedGoogle Scholar
  • 28 Huisveld IA, Leenen R, Kooy K. et al Body composition and weight reduction in relation to antigen and activity of plasminogen activator inhibitor (PAI-1) in overweight individuals. Fibrinolysis 1990; 4 (suppl2): 84-85
    PubMedGoogle Scholar
  • 29 Juhan-Vague I, Alessi MC, Vague P. Increased plasma plasminogen activator inhibitor 1 levels. A possible link between insulin resistance and atherothrombosis. Diabetologia 1991; 34: 457-462
    CrossrefPubMedGoogle Scholar
  • 30 Andersen P, Arnesen H, Hjermann I. Hyperlipoproteinemia and reduced fibrinolytic activity in healthy coronary high-risk men. Acta Med Scand 1981; 209: 199-202
    PubMedGoogle Scholar