Thromboelastography-Based Profiling of Coagulation Status in Patients Undergoing Bariatric Surgery: Analysis of 422 Patients

• Published in: Obesity surgery Vol. 31; no. 8; pp. 3590 - 3597
• Main Authors: Cowling, John C., Zhang, Xu, Bajwa, Kulvinder S., Elliott, Ekatarina G., Felinski, Melissa M., Holihan, Julie, Scerbo, Michelle, Snyder, Brad E., Trahan, Michael D., Wilson, Todd D., Courtney, Sharon L., Klein, Connie L., Rivera, Angielyn R., Wilson, Erik B., Shah, Shinil K., Cattano, Davide
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2021; Springer Nature B.V
• Subjects: Bariatric Surgery; Blood Coagulation; Blood Coagulation Tests; Body mass index; Female; Females; Gastrointestinal surgery; Humans; Male; Medicine; Medicine & Public Health; Obesity; Obesity, Morbid - surgery; Original Contributions; Surgery; Thrombelastography; Thromboelastography; Bariatric; Coagulopathy; Coagulation; Risk stratification
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-021-05445-3

Introduction/Purpose Some clinical indicators suggest hypercoagulability/hyperaggregability in patients with morbid obesity. Thromboelastography (TEG®) has been used to profile coagulation status in surgical patients. We aimed to assess coagulation profiles in patients with morbid obesity undergoing bariatric surgery by correlating demographic and patient characteristics to pre-operative TEG® values. Materials and Methods Pre-operative TEG® values from 422 patients undergoing bariatric surgery were evaluated. TEG® results were analyzed by gender, use of medications known to alter the coagulation profile, and body mass index (BMI). Results Patients have a mean of 45.03 ± 11.8 years, female (76.3%), and with a mean BMI of 42 kg/m 1 . The overall coagulation profile of female patients was significantly different from males, even in the sub-cohort without use of medications known to alter coagulation. The majority of patients (94%) with a G value > 15 dynes/cm 1 (clot strength) were female. In females, there was no association between BMI and TEG® values; however, in men, there was a statistically significant difference in TEG® values for those with BMI < 40 kg/m 1 compared to those with BMI > 50 kg/m 2 . Conclusions TEG®-based analysis of coagulation profiles offers unique insights. Compared to laboratory normal values ( R time, angle, maximal amplitude, and G values), patients with morbid obesity may have a tendency for hypercoagulability/hyperaggregability, with mean values at the higher limit. A significant hypercoagulable difference in TEG® values was identified in female as compared to male patients. Male patients with a BMI greater than 50 kg/m 2 were also found to be increasingly hypercoagulable. Graphical abstract