Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis

Charlotte Røn Stolberg; Lene Hymøller Mundbjerg; Peter Funch-Jensen; Bibi Gram; Claus Bogh Juhl; Else Marie Bladbjerg

doi:10.1016/j.soard.2018.03.022

Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis

Charlotte Røn Stolberg^*, Lene Hymøller Mundbjerg, Peter Funch-Jensen, Bibi Gram, Claus Bogh Juhl, Else Marie Bladbjerg

^*Corresponding author for this work

Aarhus University Hospital

Research output: Contribution to journal › Journal article › Research › peer-review

Abstract

BACKGROUND: The risk of cardiovascular disease is reduced by bariatric surgery, but it is unknown if exercise after bariatric surgery reduces this risk even further.

OBJECTIVE: To investigate if Roux-en-Y-gastric bypass (RYGB) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation, fibrin clot properties, and fibrinolysis.

SETTING: Bariatric center, Hospital of Southwest Jutland, Denmark.

METHODS: Sixty obese patients underwent RYGB and 6 months after RYGB were randomized to 26 weeks of physical training or a control group. Biomarkers within coagulation activation, fibrin clot properties, and fibrinolysis were measured presurgery, and 6, 12, and 24 months postsurgery.

RESULTS: Six months after RYGB, the endogenous thrombin potential decreased from 1744 (1603-2003) to 1416 (1276-1582) nM × min (P<.001). Alterations in fibrin clot properties resulted in an increased clot lysis from 23.8% (16.1%-38.9%) to 40.3% (28.5%-59.35; P<.0001). Furthermore, fibrinogen was reduced from 12.6 (11.1-14.7) to 11.5 (9.90-13.3) µM (P<.001), and plasminogen activator inhibitor antigen was reduced from 40.5 (28.4-49.4) to 24.4 (15.4-32.7) ng/mL (P<.0001). Physical training after RYGB increased fibrinolytic activity from 58.0 (36.0-75.5) to 88.0 (66.0-132.0) IU/mL compared with 52.5 (30.0-80.0) to 64.0 (49.0-100.0) IU/mL in controls (P<.01) and reduced plasminogen activator inhibitor antigen from 23.5 (16.7-35.4) to 18.1 (14.3-25.4) ng/mL compared with 24.4 (13.9-28.7) to 24.2 (14.1-29.6) ng/mL in controls (P<.05). No effects of physical training were observed on markers of coagulation activation and fibrin clot properties.

CONCLUSION: We observed favorable long-term reductions in markers of thrombin generation, improved fibrin clot properties, and increases in fibrinolysis after RYGB. Supervised physical training after RYGB further increased fibrinolysis.

Original language	English
Journal	Surgery for Obesity and Related Diseases
Volume	14
Issue number	7
Pages (from-to)	918-926
ISSN	1550-7289
DOIs	https://doi.org/10.1016/j.soard.2018.03.022
Publication status	Published - Jul 2018

Bibliographical note

Keywords

Adult
Biomarkers/analysis
Blood Chemical Analysis
Blood Coagulation/physiology
Body Mass Index
Cardiovascular Diseases/prevention & control
Denmark
Exercise Therapy/methods
Female
Fibrin Clot Lysis Time
Fibrinolysis/physiology
Follow-Up Studies
Gastric Bypass/methods
Humans
Male
Middle Aged
Obesity, Morbid/diagnosis
Postoperative Period
Reference Values
Risk Assessment
Thrombin/analysis
Time Factors
Treatment Outcome

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10.1016/j.soard.2018.03.022

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Cite this

@article{f69426a17acc4e5bb5d3f6ebb3c757da,

title = "Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis",

abstract = "BACKGROUND: The risk of cardiovascular disease is reduced by bariatric surgery, but it is unknown if exercise after bariatric surgery reduces this risk even further.OBJECTIVE: To investigate if Roux-en-Y-gastric bypass (RYGB) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation, fibrin clot properties, and fibrinolysis.SETTING: Bariatric center, Hospital of Southwest Jutland, Denmark.METHODS: Sixty obese patients underwent RYGB and 6 months after RYGB were randomized to 26 weeks of physical training or a control group. Biomarkers within coagulation activation, fibrin clot properties, and fibrinolysis were measured presurgery, and 6, 12, and 24 months postsurgery.RESULTS: Six months after RYGB, the endogenous thrombin potential decreased from 1744 (1603-2003) to 1416 (1276-1582) nM × min (P<.001). Alterations in fibrin clot properties resulted in an increased clot lysis from 23.8\% (16.1\%-38.9\%) to 40.3\% (28.5\%-59.35; P<.0001). Furthermore, fibrinogen was reduced from 12.6 (11.1-14.7) to 11.5 (9.90-13.3) µM (P<.001), and plasminogen activator inhibitor antigen was reduced from 40.5 (28.4-49.4) to 24.4 (15.4-32.7) ng/mL (P<.0001). Physical training after RYGB increased fibrinolytic activity from 58.0 (36.0-75.5) to 88.0 (66.0-132.0) IU/mL compared with 52.5 (30.0-80.0) to 64.0 (49.0-100.0) IU/mL in controls (P<.01) and reduced plasminogen activator inhibitor antigen from 23.5 (16.7-35.4) to 18.1 (14.3-25.4) ng/mL compared with 24.4 (13.9-28.7) to 24.2 (14.1-29.6) ng/mL in controls (P<.05). No effects of physical training were observed on markers of coagulation activation and fibrin clot properties.CONCLUSION: We observed favorable long-term reductions in markers of thrombin generation, improved fibrin clot properties, and increases in fibrinolysis after RYGB. Supervised physical training after RYGB further increased fibrinolysis.",

keywords = "Adult, Biomarkers/analysis, Blood Chemical Analysis, Blood Coagulation/physiology, Body Mass Index, Cardiovascular Diseases/prevention \& control, Denmark, Exercise Therapy/methods, Female, Fibrin Clot Lysis Time, Fibrinolysis/physiology, Follow-Up Studies, Gastric Bypass/methods, Humans, Male, Middle Aged, Obesity, Morbid/diagnosis, Postoperative Period, Reference Values, Risk Assessment, Thrombin/analysis, Time Factors, Treatment Outcome",

author = "Stolberg, \{Charlotte R{\o}n\} and Mundbjerg, \{Lene Hym{\o}ller\} and Peter Funch-Jensen and Bibi Gram and Juhl, \{Claus Bogh\} and Bladbjerg, \{Else Marie\}",

year = "2018",

month = jul,

doi = "10.1016/j.soard.2018.03.022",

language = "English",

volume = "14",

pages = "918--926",

journal = "Surgery for Obesity and Related Diseases",

issn = "1550-7289",

publisher = "Elsevier",

number = "7",

}

Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis. / Stolberg, Charlotte Røn ; Mundbjerg, Lene Hymøller; Funch-Jensen, Peter et al.
In: Surgery for Obesity and Related Diseases, Vol. 14, No. 7, 07.2018, p. 918-926.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis

AU - Stolberg, Charlotte Røn

AU - Mundbjerg, Lene Hymøller

AU - Funch-Jensen, Peter

AU - Gram, Bibi

AU - Juhl, Claus Bogh

AU - Bladbjerg, Else Marie

PY - 2018/7

Y1 - 2018/7

N2 - BACKGROUND: The risk of cardiovascular disease is reduced by bariatric surgery, but it is unknown if exercise after bariatric surgery reduces this risk even further.OBJECTIVE: To investigate if Roux-en-Y-gastric bypass (RYGB) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation, fibrin clot properties, and fibrinolysis.SETTING: Bariatric center, Hospital of Southwest Jutland, Denmark.METHODS: Sixty obese patients underwent RYGB and 6 months after RYGB were randomized to 26 weeks of physical training or a control group. Biomarkers within coagulation activation, fibrin clot properties, and fibrinolysis were measured presurgery, and 6, 12, and 24 months postsurgery.RESULTS: Six months after RYGB, the endogenous thrombin potential decreased from 1744 (1603-2003) to 1416 (1276-1582) nM × min (P<.001). Alterations in fibrin clot properties resulted in an increased clot lysis from 23.8% (16.1%-38.9%) to 40.3% (28.5%-59.35; P<.0001). Furthermore, fibrinogen was reduced from 12.6 (11.1-14.7) to 11.5 (9.90-13.3) µM (P<.001), and plasminogen activator inhibitor antigen was reduced from 40.5 (28.4-49.4) to 24.4 (15.4-32.7) ng/mL (P<.0001). Physical training after RYGB increased fibrinolytic activity from 58.0 (36.0-75.5) to 88.0 (66.0-132.0) IU/mL compared with 52.5 (30.0-80.0) to 64.0 (49.0-100.0) IU/mL in controls (P<.01) and reduced plasminogen activator inhibitor antigen from 23.5 (16.7-35.4) to 18.1 (14.3-25.4) ng/mL compared with 24.4 (13.9-28.7) to 24.2 (14.1-29.6) ng/mL in controls (P<.05). No effects of physical training were observed on markers of coagulation activation and fibrin clot properties.CONCLUSION: We observed favorable long-term reductions in markers of thrombin generation, improved fibrin clot properties, and increases in fibrinolysis after RYGB. Supervised physical training after RYGB further increased fibrinolysis.

AB - BACKGROUND: The risk of cardiovascular disease is reduced by bariatric surgery, but it is unknown if exercise after bariatric surgery reduces this risk even further.OBJECTIVE: To investigate if Roux-en-Y-gastric bypass (RYGB) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation, fibrin clot properties, and fibrinolysis.SETTING: Bariatric center, Hospital of Southwest Jutland, Denmark.METHODS: Sixty obese patients underwent RYGB and 6 months after RYGB were randomized to 26 weeks of physical training or a control group. Biomarkers within coagulation activation, fibrin clot properties, and fibrinolysis were measured presurgery, and 6, 12, and 24 months postsurgery.RESULTS: Six months after RYGB, the endogenous thrombin potential decreased from 1744 (1603-2003) to 1416 (1276-1582) nM × min (P<.001). Alterations in fibrin clot properties resulted in an increased clot lysis from 23.8% (16.1%-38.9%) to 40.3% (28.5%-59.35; P<.0001). Furthermore, fibrinogen was reduced from 12.6 (11.1-14.7) to 11.5 (9.90-13.3) µM (P<.001), and plasminogen activator inhibitor antigen was reduced from 40.5 (28.4-49.4) to 24.4 (15.4-32.7) ng/mL (P<.0001). Physical training after RYGB increased fibrinolytic activity from 58.0 (36.0-75.5) to 88.0 (66.0-132.0) IU/mL compared with 52.5 (30.0-80.0) to 64.0 (49.0-100.0) IU/mL in controls (P<.01) and reduced plasminogen activator inhibitor antigen from 23.5 (16.7-35.4) to 18.1 (14.3-25.4) ng/mL compared with 24.4 (13.9-28.7) to 24.2 (14.1-29.6) ng/mL in controls (P<.05). No effects of physical training were observed on markers of coagulation activation and fibrin clot properties.CONCLUSION: We observed favorable long-term reductions in markers of thrombin generation, improved fibrin clot properties, and increases in fibrinolysis after RYGB. Supervised physical training after RYGB further increased fibrinolysis.

KW - Adult

KW - Biomarkers/analysis

KW - Blood Chemical Analysis

KW - Blood Coagulation/physiology

KW - Body Mass Index

KW - Cardiovascular Diseases/prevention & control

KW - Denmark

KW - Exercise Therapy/methods

KW - Female

KW - Fibrin Clot Lysis Time

KW - Fibrinolysis/physiology

KW - Follow-Up Studies

KW - Gastric Bypass/methods

KW - Humans

KW - Male

KW - Middle Aged

KW - Obesity, Morbid/diagnosis

KW - Postoperative Period

KW - Reference Values

KW - Risk Assessment

KW - Thrombin/analysis

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.soard.2018.03.022

DO - 10.1016/j.soard.2018.03.022

M3 - Journal article

C2 - 29706497

AN - SCOPUS:85046125017

SN - 1550-7289

VL - 14

SP - 918

EP - 926

JO - Surgery for Obesity and Related Diseases

JF - Surgery for Obesity and Related Diseases

IS - 7

ER -

Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis

Abstract

Bibliographical note

Keywords

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