Effects of obesity surgery on blood coagulation and fibrinolysis: a literature review
Open accessAbstract
OBJECTIVE: Obesity is characterized by a disturbed hemostatic balance with increased coagulation and impaired fibrinolysis. This increases the risk of thrombosis, and the risk is lowered after obesity surgery. Over the past 25 years, several studies have contributed to understand the mechanisms behind the antithrombotic effect of obesity surgery, and this literature review summarizes the results of these studies. METHODS: A detailed literature search on the effects of obesity surgery on the hemostatic balance was conducted. RESULTS: The 25 relevant studies reviewed demonstrated that obesity surgery has favorable effects on many biomarkers of coagulation and fibrinolysis. The evidence is substantial for fibrinogen and plasminogen activator inhibitor type 1 with average reductions from 1 to 24 months after obesity surgery of 17 and 48%, respectively. For most other biomarkers, the evidence is moderate or weak with average effect sizes varying from 2% for fiber mass length ratio to 70% for prothrombin fragment 1 + 2 and with a large variation between studies. Many studies are small and of short duration, and the surgical techniques differ. Also, studies are confounded by changes in medication, comorbidity, diet, and exercise. It is unknown whether the hemostatic changes are mediated by weight loss alone or by the accompanying metabolic improvements. CONCLUSION: Despite issues of confounding, this review suggests that obesity surgery shifts the hemostatic balance in the antithrombotic direction, thereby reducing the thrombotic potential of people with obesity, but more studies are needed for most of the biomarkers.
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For tPA, the evidence is limited and inconsistent.
“For tPA, the evidence is limited and inconsistent. 50”
From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [50]
A systematic review of bariatric surgery showed consistent reductions in PAI-1, with pooled effect sizes indicating 40% to 60% decreases.
“a systematic review of bariatric sur gery showed consistent reductions in PAI-1, with pooled effect sizes indicating 40% to 60% decreases, 50”
From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [50]
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Reduction of coagulability state one year after bariatric surgery
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Leukocyte Activation in Obese Patients
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Thromboelastography Values Remain Hypercoagulative 6 Months After Obesity Surgery: a Pilot Study
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PAI-1 and α2-AP in patients with morbid obesity.
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Thrombin Generation Measurements in Patients Scheduled for Laparoscopic Bariatric Surgery
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Obesity and COVID‐19: An Italian Snapshot
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The dark side of the spoon - glucose, ketones and COVID-19: a possible role for ketogenic diet?
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Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review
Vulturar, D.-M., Crivii, C. B., Orasan, O. H., Palade, E., Buzoianu, A. D., Zehan, I.-G., & Todea, D. A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11133844 · Cited by 33 · see citing works
A Systematic Review of Proteomics in Obesity: Unpacking the Molecular Puzzle
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Mechanisms of Hypercoagulability Driving Stroke Risk in Obesity
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Pregnancy and post-partum outcomes of obese women after bariatric surgery: A case-control study
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Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide
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The Impact of Prior Obesity Surgery on Bleeding after Abdominal Body Contouring Surgery
Badran, S. M., Braizat, O., Aljassem, G., Alyazji, Z. T. N., Farsakoury, R., Iskeirjeh, S., Asim, M., Glass, G. E., & Muneer, M. T. (2024) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000005959 · Cited by 4 · see citing works
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Changes in fibrin clot properties in patients after Roux-en-Y gastric bypass surgery
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Contact activated kallikrein generation is reduced six months after gastric bypass
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Characterization of the blood coagulation system in morbidly obese patients
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Biochemistry and laboratory diagnosis of obesity
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PS09-02 閉塞性黄疸における腸管粘膜固有層のTリンパ球分布の変化
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Analysis of Hemostasis Function in Obesity Subjects Using Thromboelastography
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Coagulation activation in anorexia nervosa: increased tissue factor and prothrombin fragment 1+2
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- Authors
- Bladbjerg, E. M., Stolberg, C. R., & Juhl, C. B.
- Affiliations
- University of Southern Denmark (DK)
- Venue
- Thrombosis and Haemostasis
- Publisher
- Georg Thieme Verlag KG
- Published
- 2020-04
- Volume
- 120
- Issue
- 04
- Pages
- 579-591
- ISSN
- 0340-6245 (ISSN-L)
- 2567-689X
- OpenAlex
- W3015241468
- Cited by
- 43
- References
- 107
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 9 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 3
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Blood properties and coagulation
- Keywords
- bariatric surgery, coagulation, fibrinolysis, hemostasis, thrombosis risk, fibrinogen, plasminogen activator inhibitor-1, prothrombin fragment 1+2, weight loss, metabolic improvement
- MeSH terms
- Animals, Blood Coagulation, Fibrinolysis, Hemostasis, Humans, Obesity, Thrombosis, Biomarkers, Treatment Outcome, Bariatric Surgery
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