Vanessa N VanDruff, Fakiha Siddiqui, Kristine Kuchta, Julia R Amundson, Christopher J Zimmermann, H Mason Hedberg, John Linn, Woody Denham, Jawed Fareed, Michael B Ujiki
{"title":"肥胖患者术前生物标志物和血栓弹性测定法对静脉血栓栓塞风险分层的影响:临床风险评估足够吗?","authors":"Vanessa N VanDruff, Fakiha Siddiqui, Kristine Kuchta, Julia R Amundson, Christopher J Zimmermann, H Mason Hedberg, John Linn, Woody Denham, Jawed Fareed, Michael B Ujiki","doi":"10.1097/XCS.0000000000001416","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Obesity is associated with substantial thromboembolic risk; however, no standard laboratory method exists to stratify risk for postoperative thrombotic events. Our aim was to evaluate preoperative prothrombotic biomarkers and thromboelastometry in relationship to clinical venothromboembolism stratification in bariatric patients.</p><p><strong>Study design: </strong>Preoperative blood samples were assessed for rotational thromboelastometry, D-dimer, C-reactive protein (CRP), plasminogen activator inhibitor-1, von Willebrand factor, and P-selectin, and compared with 50 normal control (NC) samples. Patients were stratified into Caprini Risk Score (CRS) groups: moderate (3 to 4), high (5 to 8), and very high (greater than 8) venothromboembolism risk.</p><p><strong>Results: </strong>One hundred bariatric patients were assessed and risk stratified to CRS 3 to 4 (23), CRS 5 to 8 (67), and CRS greater than 8 (10). D-dimer, plasminogen activator inhibitor-1, and CRP were increased compared with NC, all p < 0.001, and P-selectin and von Willebrand factor demonstrated no differences compared with NC. D-dimer demonstrated significant differences between moderate, high, and very high-risk groups (all p < 0.05), and positive correlation with CRS ( r = 0.44, p < 0.001). On thromboelastometry, clot formation time (CFT) was faster than normal in 18% of patients, with maximum clot firmness higher than normal in 54% of patients. No difference was found comparing thromboelastometry between CRS groups. Significant correlations were found between CRP and CFT ( r = -0.44), α-angle ( r = 0.40), and maximum clot firmness ( r = 0.44), all p < 0.05, respectively. D-dimer negatively correlated with CFT ( r = -0.34, p < 0.05), and clotting time ( r = -0.78, p < 0.05) in very high-risk patients.</p><p><strong>Conclusions: </strong>Preoperative D-dimer and CRP are significantly increased in bariatric patients and correlate with prothrombotic features on thromboelastometry. No significant differences were found comparing viscoelastic tests among CRS groups, which suggests patients with marked prothrombotic findings are not being differentiated into higher-risk categories by clinical assessment alone.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"67-76"},"PeriodicalIF":3.8000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preoperative Biomarkers and Thromboelastometry According to Caprini Venous Thromboembolism Risk Stratification in Bariatric Patients: Are Clinical Risk Assessments Enough?\",\"authors\":\"Vanessa N VanDruff, Fakiha Siddiqui, Kristine Kuchta, Julia R Amundson, Christopher J Zimmermann, H Mason Hedberg, John Linn, Woody Denham, Jawed Fareed, Michael B Ujiki\",\"doi\":\"10.1097/XCS.0000000000001416\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Obesity is associated with substantial thromboembolic risk; however, no standard laboratory method exists to stratify risk for postoperative thrombotic events. Our aim was to evaluate preoperative prothrombotic biomarkers and thromboelastometry in relationship to clinical venothromboembolism stratification in bariatric patients.</p><p><strong>Study design: </strong>Preoperative blood samples were assessed for rotational thromboelastometry, D-dimer, C-reactive protein (CRP), plasminogen activator inhibitor-1, von Willebrand factor, and P-selectin, and compared with 50 normal control (NC) samples. Patients were stratified into Caprini Risk Score (CRS) groups: moderate (3 to 4), high (5 to 8), and very high (greater than 8) venothromboembolism risk.</p><p><strong>Results: </strong>One hundred bariatric patients were assessed and risk stratified to CRS 3 to 4 (23), CRS 5 to 8 (67), and CRS greater than 8 (10). D-dimer, plasminogen activator inhibitor-1, and CRP were increased compared with NC, all p < 0.001, and P-selectin and von Willebrand factor demonstrated no differences compared with NC. D-dimer demonstrated significant differences between moderate, high, and very high-risk groups (all p < 0.05), and positive correlation with CRS ( r = 0.44, p < 0.001). On thromboelastometry, clot formation time (CFT) was faster than normal in 18% of patients, with maximum clot firmness higher than normal in 54% of patients. No difference was found comparing thromboelastometry between CRS groups. Significant correlations were found between CRP and CFT ( r = -0.44), α-angle ( r = 0.40), and maximum clot firmness ( r = 0.44), all p < 0.05, respectively. D-dimer negatively correlated with CFT ( r = -0.34, p < 0.05), and clotting time ( r = -0.78, p < 0.05) in very high-risk patients.</p><p><strong>Conclusions: </strong>Preoperative D-dimer and CRP are significantly increased in bariatric patients and correlate with prothrombotic features on thromboelastometry. No significant differences were found comparing viscoelastic tests among CRS groups, which suggests patients with marked prothrombotic findings are not being differentiated into higher-risk categories by clinical assessment alone.</p>\",\"PeriodicalId\":17140,\"journal\":{\"name\":\"Journal of the American College of Surgeons\",\"volume\":\" \",\"pages\":\"67-76\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American College of Surgeons\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/XCS.0000000000001416\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/XCS.0000000000001416","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/13 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Preoperative Biomarkers and Thromboelastometry According to Caprini Venous Thromboembolism Risk Stratification in Bariatric Patients: Are Clinical Risk Assessments Enough?
Background: Obesity is associated with substantial thromboembolic risk; however, no standard laboratory method exists to stratify risk for postoperative thrombotic events. Our aim was to evaluate preoperative prothrombotic biomarkers and thromboelastometry in relationship to clinical venothromboembolism stratification in bariatric patients.
Study design: Preoperative blood samples were assessed for rotational thromboelastometry, D-dimer, C-reactive protein (CRP), plasminogen activator inhibitor-1, von Willebrand factor, and P-selectin, and compared with 50 normal control (NC) samples. Patients were stratified into Caprini Risk Score (CRS) groups: moderate (3 to 4), high (5 to 8), and very high (greater than 8) venothromboembolism risk.
Results: One hundred bariatric patients were assessed and risk stratified to CRS 3 to 4 (23), CRS 5 to 8 (67), and CRS greater than 8 (10). D-dimer, plasminogen activator inhibitor-1, and CRP were increased compared with NC, all p < 0.001, and P-selectin and von Willebrand factor demonstrated no differences compared with NC. D-dimer demonstrated significant differences between moderate, high, and very high-risk groups (all p < 0.05), and positive correlation with CRS ( r = 0.44, p < 0.001). On thromboelastometry, clot formation time (CFT) was faster than normal in 18% of patients, with maximum clot firmness higher than normal in 54% of patients. No difference was found comparing thromboelastometry between CRS groups. Significant correlations were found between CRP and CFT ( r = -0.44), α-angle ( r = 0.40), and maximum clot firmness ( r = 0.44), all p < 0.05, respectively. D-dimer negatively correlated with CFT ( r = -0.34, p < 0.05), and clotting time ( r = -0.78, p < 0.05) in very high-risk patients.
Conclusions: Preoperative D-dimer and CRP are significantly increased in bariatric patients and correlate with prothrombotic features on thromboelastometry. No significant differences were found comparing viscoelastic tests among CRS groups, which suggests patients with marked prothrombotic findings are not being differentiated into higher-risk categories by clinical assessment alone.
期刊介绍:
The Journal of the American College of Surgeons (JACS) is a monthly journal publishing peer-reviewed original contributions on all aspects of surgery. These contributions include, but are not limited to, original clinical studies, review articles, and experimental investigations with clear clinical relevance. In general, case reports are not considered for publication. As the official scientific journal of the American College of Surgeons, JACS has the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.