PB0125 - Preoperative Thromboelastometry and Pro-thrombotic Biomarkers According to Clinical Venothromboembolic (VTE) Risk Assessment in Bariatric Surgery Patients

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

Vanessa N. VanDruff, MD

Resident
NorthShore University Health System
Chicago, Illinois, United States

Co-Author(s)

AT

Alfonso Tafur, MD, MS, MBA (he/him/his)

Attending Physician, Senior Author
Northshore University HealthSystem, Cardiovascular Institute
Evanston, Illinois, United States

Presenting Author(s)

Fakiha Siddiqui, PhD Candidate

PhD Candidate
Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.
Maywood, Illinois, United States

Co-Author(s)

Srdjan S. Nikolovski, MD

Sr Staff Scientist
Loyola University Chicago
Lyons, Illinois, United States
JF

Jawed Fareed, n/a

Professor
Loyola University Medical Center
MAYWOOD, Illinois, United States
KK

Kristine Kuchta

Statistician
NorthShore University HealthSystem
Evanston, Illinois, United States
JC

JoAnn Carbray

Research Coordinator
NorthShore University HealthSystem
Evanston, Illinois, United States
CM

Caroline Meyer

Research Assistant
NorthShore University HealthSystem
Evanston, Illinois, United States
JA

Julia R. Amundson

Resident
NorthShore University HealthSystem
Chicago, Illinois, United States
SJ

Stephanie Joseph

Resident
Wayne State University
Chicago, Illinois, United States
SC

Simon Che

Attending
NorthShore University HealthSystem
Evanston, Illinois, United States
CZ

Christopher Zimmermann

Fellow
NorthShore University HealthSystem
Evanston, Illinois, United States
HH

H. Mason Hedberg

Attending
NorthShore University HealthSystem
Evanston, Illinois, United States
SH

Steven Haggerty

Attending
NorthShore University HealthSystem
Evanston, Illinois, United States
JL

John Linn

Attending
NorthShore University HealthSystem
Evanston, Illinois, United States
WD

Woody Denham

Attending
NorthShore University HealthSystem
Evanston, Illinois, United States
MU

Michael B. Ujiki

Attending
NorthShore University Health System
Evanston, Illinois, United States

Background: Obesity is associated with substantial thromboembolic risk however no standard laboratory method exists to stratify risk for post-operative thrombotic events.

Aims: Our aim is to evaluate pro-thrombotic biomarkers and thromboelastometry in relationship to clinical VTE risk stratification in bariatric patients.

Methods: Preoperative blood samples were assessed for rotational thromboelastometry, D-Dimer, C-Reactive Protein (CRP), Plasminogen Activator Inhibitor-1 (PAI-1), von Willebrand factor (vWF), and Endocan. Patients were stratified and compared by Caprini Risk Score (CRS), low (<=4) vs. high (>=5) VTE risk. Analyses were performed using Mann-Whitney test and Spearman correlation coefficients.

Results: Fifty preoperative bariatric patients were assessed (78% female, mean BMI 46.4±5.8), 11 patients with CRS <=4 and 39 with CRS >=5. Thromboinflammatory biomarkers were higher in bariatric samples compared to normal controls, increased 10.29-fold in D-Dimer and 3.16-fold in CRP (Table 1). D-dimer was significantly higher in the CRS>=5 group (p < 0.01) and positively correlated with CRS (r= 0.45, p< 0.01). No difference was found in CRP, vWF, PAI, or Endocan between CRS groups. In Table 2, clotting time was faster in patients with CRS >=5 on assays testing extrinsic (EXTEM), intrinsic (INTEM), and fibrin-dependent (FIBTEM) coagulation (all p< 0.03), and was negatively correlated with CRS, (r=-0.37 to -0.40, all p< 0.01). Maximal clot firmness (MCF) was elevated in 52% of all patients on EXTEM, 14.6% on INTEM, and 41.7% on FIBTEM, however, no difference was demonstrated between groups. Moderate correlations were found between CRP and clotting factor time (r=-0.39 to -0.53), alpha angle (r=-0.45 to-0.5) and MCF (r=-0.39 to 0.58), all p< 0.05, in patients with CR>=5.

Conclusion(s): Thromboinflammatory markers are markedly increased in pre-bariatric patients. Although D-dimer correlates with CRS, CRP demonstrates the strongest correlation with thromboelastometry in high-risk patients. Further study is warranted to evaluate if D-dimer and CRP may be used as adjuncts to clinical VTE risk assessment.