Obesity and risk of bleeding: the SMART study

Essentials Whether obesity protects against clinically relevant bleeding is unclear. We investigated the risk of bleeding according to various measures of obesity in a cohort of 9736 patients. Obesity was not associated with a lower risk of bleeding. The procoagulant profile in obese subjects may no...

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Vydané v:Journal of thrombosis and haemostasis Ročník 14; číslo 1; s. 65 - 72
Hlavní autori: Braekkan, S. K., Graaf, Y., Visseren, F. L. J., Algra, A.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England Elsevier Limited 01.01.2016
Predmet:
Administration, Oral
Adolescent
Adult
Aged
Anthropometry
Anticoagulants - chemistry
bleeding
Body Mass Index
Coagulants - chemistry
Female
Fibrinolysis
Follow-Up Studies
Health risk assessment
hemorrhage
Hemorrhage - complications
Hemorrhage - diagnosis
Hemostasis
Humans
Male
Middle Aged
Obesity
Obesity - complications
Obesity - diagnosis
Proportional Hazards Models
Prospective Studies
Risk Factors
Young Adult
risk factors
bleeding
anthropometry
obesity
hemorrhage
ISSN:1538-7933, 1538-7836, 1538-7836
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Shrnutí:Essentials Whether obesity protects against clinically relevant bleeding is unclear. We investigated the risk of bleeding according to various measures of obesity in a cohort of 9736 patients. Obesity was not associated with a lower risk of bleeding. The procoagulant profile in obese subjects may not be enough to protect against clinically relevant bleeding. Summary Background Obesity is associated with increased levels of procoagulant factors and decreased fibrinolytic activity. Whether this hemostatic profile protects against clinically relevant bleeding has been scarcely investigated. Objectives To assess the impact of measures of obesity on the risk of bleeding in a large cohort of patients at increased atherothrombotic risk. Methods The Second Manifestation of ARTerial disease (SMART) study included 9736 patients aged 18–79 years, followed for a median of 5.9 years. Body mass index (BMI), waist circumference and hip circumference were measured at inclusion. All incident fatal or non‐fatal hemorrhagic events were recorded. Results During follow‐up, 359 first bleeding events occurred. In quintile‐based analyses, the risk of bleeding was highest in the lowest quintile (Q) of BMI (age and sex‐adjusted HR Q2 vs. Q1, 0.68; 95% CI, 0.50–0.94), but there was a threshold effect at low BMI levels (men, < 23.84 kg m−2; women, < 22.49 kg m−2), and the risk estimates for bleeding did not further change across the remaining quintiles (HR Q3 0.81 and Q5 0.75). For waist circumference the relationship appeared to be U‐shaped, with the lowest risk of bleeding in quintile 3 (HR Q3 vs. Q1, 0.69; 95% CI, 0.46–1.04). Adjustments for hypertension, hemoglobin level, renal failure, diabetes and use of oral anticoagulants or platelet inhibitors did not affect the results. Conclusion Obesity was not associated with lower risk of bleeding. Our findings suggest that presumed protection against bleeding due to an apparently efficient hemostatic system may be counterbalanced by other factors in obese subjects.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.13184