Personalization of heparin therapy in bariatric patients using thrombodynamic testing

Introduction. Morbid obesity is associated with a high risk of venous thromboembolic complications (VTE) after bariatric surgery; however, standard risk stratification scales do not always provide sufficient predictive accuracy for this patient population, and monitoring the efficacy of anticoagulant prophylaxis remains challenging.
Aim. To evaluate the use of thrombodynamics assay for assessing the risk of VTE in patients with morbid obesity undergoing bariatric surgery, stratified according to the modified Caprini-B score, and to analyze the dynamics of hemostasis parameters during anticoagulant prophylaxis.
Materials and methods. A prospective observational study included 113 patients with morbid obesity (BMI 44.5 ± 8.0 kg/m2) who underwent laparoscopic bariatric procedures. Patients were divided into two groups: moderate risk (7–11 points on the Caprini-B score, n = 63) and high risk (≥12 points, n = 50). VTE prophylaxis was performed with nadroparin calcium (38–57 anti-Xa IU/kg) for at least 21 days. Thrombodynamics assay was performed before surgery, immediately after surgery, and on postoperative day 4.
Results. No clinically significant VTE events were registered in either group. In high-risk patients, baseline hypercoagulation was detected (clot growth velocity V – 33.0 ± 2.5 μm/min vs. normal range 20–29 μm/min, p < 0.05), which increased after surgery. By day 4, nadroparin therapy achieved normocoagulation in the moderate-risk group; in the high-risk group, hypercoagulation decreased and stabilized at the upper limit of normal. No hemorrhagic complications were observed.
Conclusions. Thrombodynamics assay provides an objective assessment of hemostasis in bariatric patients and enables monitoring of anticoagulant prophylaxis efficacy. The most informative parameters are clot growth velocity and clot size (V, Vst, CS). In patients with ≥12 points on the Caprini-B score, hypercoagulation persists at the upper normal limit by day 4, which may require extended or intensified anticoagulant therapy

1. Ametov AS, Pashkova EYu, Ramazanova ZD, Darsigova MN. Obesity as a non-infectious epidemic of the XXI century. Modern ideas about the pathogenesis, risks and approaches to pharmacotherapy. Endocrinology: News, Opinions, Training. 2019;8(2):57–66. (In Russ.) https://doi.org/10.24411/2304-9529-2019-12007.

2. Strizheletsky VV, Gomon YuM, Spichakova EA, Kolbin AS, Makarov SA, Lomia AB et al. Clinical and economic analysis of bariatric interventions in the treatment of obesity in the Russian Federation. Endoscopic Surgery. 2023;29(3):5–14. (In Russ.) https://doi.org/10.17116/endoskop2023290315.

3. Leskova IV, Ershova EV, Nikitina EA, Krasnikovsky VYa, Ershova YuA, Adamskaya LV. Obesity in Russia: modern view in the light of a social problems. Obesity and Metabolism. 2019;16(1):20–26. (In Russ.) https://doi.org/10.14341/omet9988.

4. Sedleckij YuI, Аnisimova КА, Malyhina AI, Vasilevsky DI, Balandov SG, Davletbaeva LI. Features of management of bariatric patients in the late postoperative period. MEDLINE.RU. 2018;19:1155–1168. (In Russ.) Available at: https://medline.ru/public/art/tom19/art82.html.

5. Jung YJ. Obesity and Venous Thromboembolism: Mechanisms, Clinical Implications, and Prevention Strategies With a Focus on Bariatric Surgery. J Metab Bariatr Surg. 2025;14(2):131–138. https://doi.org/10.17476/jmbs.2025.14.2.131.

6. Seliverstov EI, Lobastov KV, Ilyukhin EA, Apkhanova TV, Akhmetzyanov RV, Akhtyamov IF et al. Prevention, Diagnostics and Treatment of Deep Vein Thrombosis. Russian Experts Consensus. Flebologiya. 2023;17(3):152–296. (In Russ.) https://doi.org/10.17116/flebo202317031152.

7. Belenkov YuN, Golub AV, Popova LV, Shelest EA, Patrushev LI, Kondratieva TV et al. The influence of thrombophilia and obesity on the risk of venous thrombosis. Clinical Medicine (Russian Journal). 2017;95(6):545–548. (In Russ.) Available at: https://elibrary.ru/zhkopd.

8. Kalfarentzos F, Stavropoulou F, Yarmenitis S, Kehagias I, Karamesini M, Dimitrakopoulos A, Maniati A. Prophylaxis of venous thromboembolism using two different doses of low-molecular-weight heparin (nadroparin) in bariatric surgery: a prospective randomized trial. Obes Surg. 2001;11(6):670–676. https://doi.org/10.1381/09608920160558588.

9. Chitongo PB, Roberts LN, Yang L, Patel RK, Lyall R, Luxton R et al. Visceral Adiposity Is an Independent Determinant of Hypercoagulability as Measured by Thrombin Generation in Morbid Obesity. TH Open. 2017;1(2):e146–e154. https://doi.org/10.1055/s-0037-1608942.

10. Lobastov K, Barinov V, Schastlivtsev I, Laberko L, Rodoman G, Boyarintsev V. Validation of the Caprini risk assessment model for venous thromboembolism in high-risk surgical patients in the background of standard prophylaxis. J Vasc Surg Venous Lymphat Disord. 2016;4(2):153–160. https://doi.org/10.1016/j.jvsv.2015.09.004.

11. VanDruff VN, Siddiqui F, Kuchta K, Amundson JR, Zimmermann CJ, Hedberg HM et al. Preoperative Biomarkers and Thromboelastometry According to Caprini Venous Thromboembolism Risk Stratification in Bariatric Patients: Are Clinical Risk Assessments Enough? J Am Coll Surg. 2025;241(1):67–76. https://doi.org/10.1097/XCS.0000000000001416.

12. Атауллаханов ФИ, Баландина АН, Варданян ДМ, Верхоломова ФЮ, Вуймо ТА, Карамзин СС и др. Применение теста тромбодинамики для оценки состояния системы гемостаза. М.: Первый Московский государственный медицинский университет им. И.М. Сеченова; 2015. 72 с. Режим доступа: https://elibrary.ru/tjvsic.

13. Bertaggia Calderara D, Aliotta A, Zermatten MG, Kröll D, Stirnimann G, Alberio L. Hyper-coagulability in obese patients accurately identified by combinations of global coagulation assay parameters. Thromb Res. 2020;187:91–102. https://doi.org/10.1016/j.thromres.2020.01.012.

14. Campello E, Zabeo E, Radu CM, Spiezia L, Gavasso S, Fadin M et al. Hypercoagulability in overweight and obese subjects who are asymptomatic for thrombotic events. Thromb Haemost. 2015;113(1):85–96. https://doi.org/10.1160/TH14-02-0156.