Background

Obesity, an inflammatory state, contributes to hypercoagulability with elevation of coagulation factors VIII, IX and XI, fibrinogen and tissue factor. Factor VIII (FVIII) levels have been found to be elevated in patients who developed Porto-mesenteric vein thrombosis (PMVT) after Laparoscopic Sleeve Gastrectomy (LSG). Postoperative prophylactic anticoagulation therapy led to a significant reduction in PMVT without an increased risk of bleeding. This research builds on previous findings by comparing pre/post-op FVIII values 6-18 months after LSG in patients to see if these levels decrease after weight loss surgery.

Methods

We evaluated differences in pre-/post-operative FVIII levels, with changes in BMI, hyperlipidemia, HbA1c, and liver enzymes as secondary outcomes.

Results

248 patients underwent LSG between 2019 and 2022. 53 patients had pre-/post-operative FVIII levels available for analysis. 13 were excluded for having postoperative labs outside the 6-18 month timeframe. Analyzing revealed significant mean differences in weight (p= 4.3712E-07), BMI (p= 1.1023E-05), glucose levels (p=0.0074), and ALT (p=0.0059). There was a clinically significant decrease in mean FVIII (176.73 to 149.03, normal < 150), but it was not statistically significant.

Conclusions

A clinically significant reduction in FVIII was observed in most patients. Weight loss may decrease FVIII levels in LSG patients, further reducing their risk of thrombotic events. Limitations of this study include a small sample size, incomplete lab values and loss to follow up. Larger multicenter cohort study are necessary to adequately assess effect of weight loss on hypercoagulability.