Semin Thromb Hemost 2011; 37(8): 903-907
DOI: 10.1055/s-0031-1297369
© Thieme Medical Publishers

Obesity and Venous Thrombosis: A Review

Margaret A. Allman-Farinelli1
  • 1Department of Nutrition and Dietetics, School of Molecular Bioscience, University of Sydney, NSW, Australia
Further Information

Publication History

Publication Date:
23 December 2011 (online)


The world is experiencing an obesity pandemic, with rates of obesity rising for more than two decades. Obesity is defined as a body mass index (BMI) of 30 kg/m2 or greater. Of particular concern are the risks that millions of obese people are likely to develop chronic diseases and at earlier ages than their parents might have. The risk of venous thrombosis increases with obesity, so that the incidence of this pathology is also expected to rise significantly. There is remarkable and consistent evidence from a systematic review, as well as cohort and case–control studies that obesity might predispose to venous thromboembolism (VTE). The risk appears to be at least double that for normal weight subjects (BMI 20 to 24.9 kg/m2). Plausible mechanisms exist to explain this relationship, including the physical effects of body fat limiting venous return and a proinflammatory, prothrombotic, and hypofibrinolytic milieu. Loss of body weight has been shown to reduce the concentrations of coagulation factors and plasminogen activator inhibitor-1 toward the normal range. Whether weight loss would prevent secondary occurrence of VTE in the absence of anticoagulant therapy could not be discerned from this literature search.


  • 1 Nejat E J, Polotsky A J, Pal L. Predictors of chronic disease at midlife and beyond—the health risks of obesity.  Maturitas. 2010;  65 (2) 106-111
  • 2 Allman-Farinelli M A, Chey T, Bauman A E, Gill T, James W P. Age, period and birth cohort effects on prevalence of overweight and obesity in Australian adults from 1990 to 2000.  Eur J Clin Nutr. 2008;  62 (7) 898-907
  • 3 van Dam R M, Willett W C, Manson J E, Hu F B. The relationship between overweight in adolescence and premature death in women.  Ann Intern Med. 2006;  145 (2) 91-97
  • 4 Aitken R J, Allman-Farinelli M A, King L A, Bauman A. Current and future costs of cancer, heart disease and stroke attributable to obesity in Australia—a comparison of two birth cohorts.  Asia Pac J Clin Nutr. 2009;  18 63-70
  • 5 Allman-Farinelli M A, Aitken R J, King L A, Bauman A E. Osteoarthritis—the forgotten obesity-related epidemic with worse to come.  Med J Aust. 2008;  188 (5) 317
  • 6 Levin P D, Weissman C. Obesity, metabolic syndrome, and the surgical patient.  Med Clin North Am. 2009;  93 (5) 1049-1063
  • 7 Nordström M, Lindblad B, Bergqvist D, Kjellström T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population.  J Intern Med. 1992;  232 (2) 155-160
  • 8 Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen P W. Cardiovascular risk factors and venous thromboembolism: a meta-analysis.  Circulation. 2008;  117 (1) 93-102
  • 9 Di Minno G, Mannucci P M, Tufano A First Ambulatory Screening On Thromboembolism (fast) Study Group et al. The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism.  J Thromb Haemost. 2005;  3 (7) 1459-1466 [Multicenter Study]
  • 10 Samama M M. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Archives of Internal Medicine. [Research Support, Non-U.S. Govt].  2000 Dec 11–25;160(22):3415–20
  • 11 Cushman M. Epidemiology and risk factors for venous thrombosis.  Semin Hematol. 2007;  44 (2) 62-69
  • 12 Hansson P O, Eriksson H, Welin L, Svärdsudd K, Wilhelmsen L. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: “the study of men born in 1913”.  Arch Intern Med. 1999;  159 (16) 1886-1890
  • 13 Romualdi E, Squizzato A, Ageno W. Abdominal obesity and the risk of recurrent deep vein thrombosis.  Thromb Res. 2007;  119 (6) 687-690
  • 14 Eichinger S, Hron G, Bialonczyk C et al.. Overweight, obesity, and the risk of recurrent venous thromboembolism.  Arch Intern Med. 2008;  168 (15) 1678-1683
  • 15 Ageno W, Piantanida E, Dentali F et al.. Body mass index is associated with the development of the post-thrombotic syndrome.  Thromb Haemost. 2003;  89 (2) 305-309
  • 16 Darvall K A, Sam R C, Silverman S H, Bradbury A W, Adam D J. Obesity and thrombosis.  Eur J Vasc Endovasc Surg. 2007;  33 (2) 223-233 [Review]
  • 17 Van Guilder G P, Hoetzer G L, Greiner J J, Stauffer B L, DeSouza C A. Metabolic syndrome and endothelial fibrinolytic capacity in obese adults.  Am J Physiol Regul Integr Comp Physiol. 2008;  294 (1) R39-R44
  • 18 Dellas C, Schäfer K, Rohm I et al.. Absence of leptin resistance in platelets from morbidly obese individuals may contribute to the increased thrombosis risk in obesity.  Thromb Haemost. 2008;  100 (6) 1123-1129
  • 19 Chu N F, Spiegelman D, Hotamisligil G S, Rifai N, Stampfer M, Rimm E B. Plasma insulin, leptin, and soluble TNF receptors levels in relation to obesity-related atherogenic and thrombogenic cardiovascular disease risk factors among men.  Atherosclerosis. 2001;  157 (2) 495-503
  • 20 Singh P, Peterson T E, Barber K R et al.. Leptin upregulates the expression of plasminogen activator inhibitor-1 in human vascular endothelial cells.  Biochem Biophys Res Commun. 2010;  392 (1) 47-52
  • 21 Juhan-Vague I, Alessi M C. Regulation of fibrinolysis in the development of atherothrombosis: role of adipose tissue.  Thromb Haemost. 1999;  82 (2) 832-836 [Review]
  • 22 Rosito G A, D'Agostino R B, Massaro J et al.. Association between obesity and a prothrombotic state: the Framingham Offspring Study.  Thromb Haemost. 2004;  91 (4) 683-689
  • 23 Alessi M C, Juhan-Vague I. PAI-1 and the metabolic syndrome: links, causes, and consequences.  Arterioscler Thromb Vasc Biol. 2006;  26 2200-2207
  • 24 Steffen L M, Cushman M, Peacock J M et al.. Metabolic syndrome and risk of venous thromboembolism: Longitudinal Investigation of Thromboembolism Etiology.  J Thromb Haemost. 2009;  7 (5) 746-751
  • 25 Reiner A P, Siscovick D S, Rosendaal F R. Hemostatic risk factors and arterial thrombotic disease.  Thromb Haemost. 2001;  85 (4) 584-595
  • 26 Folsom A R, Qamhieh H T, Wing R R et al.. Impact of weight loss on plasminogen activator inhibitor (PAI-1), factor VII, and other hemostatic factors in moderately overweight adults.  Arterioscler Thromb. 1993;  13 (2) 162-169
  • 27 Marckmann P, Toubro S, Astrup A. Sustained improvement in blood lipids, coagulation, and fibrinolysis after major weight loss in obese subjects.  Eur J Clin Nutr. 1998;  52 (5) 329-333
  • 28 Rissanen P, Vahtera E, Krusius T, Uusitupa M, Rissanen A. Weight change and blood coagulability and fibrinolysis in healthy obese women.  Int J Obes Relat Metab Disord. 2001;  25 (2) 212-218
  • 29 Tsai A W, Cushman M, Rosamond W D, Heckbert S R, Polak J F, Folsom A R. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology.  Arch Intern Med. 2002;  162 (10) 1182-1189
  • 30 Ay C, Tengler T, Vormittag R et al.. Venous thromboembolism—a manifestation of the metabolic syndrome.  Haematologica. 2007;  92 (3) 374-380
  • 31 Lemkes B A, Hermanides J, Devries J H, Holleman F, Meijers JCM, Hoekstra JBL. Hyperglycemia: a prothrombotic factor?.  J Thromb Haemost. 2010;  8 (8) 1663-1669
  • 32 Lindqvist P G, Epstein E, Olsson H. The relationship between lifestyle factors and venous thromboembolism among women: a report from the MISS study.  Br J Haematol. 2009;  144 (2) 234-240
  • 33 van Stralen K J, Doggen CJM, Lumley T et al.. The relationship between exercise and risk of venous thrombosis in elderly people.  J Am Geriatr Soc. 2008;  56 (3) 517-522
  • 34 Van Guilder G P, Hoetzer G L, Smith D T et al.. Endothelial t-P`A release is impaired in overweight and obese adults but can be improved with regular aerobic exercise.  Am J Physiol Endocrinol Metab. 2005;  289 (5) E807-E813
  • 35 Aguilera C M, Ramírez-Tortosa M C, Mesa M D, Gil A. [Protective effect of monounsaturated and polyunsaturated fatty acids on the development of cardiovascular disease].  Nutr Hosp. 2001;  16 (3) 78-91
  • 36 Brand-Miller J, Dickinson S, Barclay A, Allman-Farinelli M. Glycemic index, glycemic load, and thrombogenesis.  Semin Thromb Hemost. 2009;  35 (1) 111-118
  • 37 Lutsey P L, Steffen L M, Virnig B A, Folsom A R. Diet and incident venous thromboembolism: the Iowa Women's Health Study.  Am Heart J. 2009;  157 (6) 1081-1087
  • 38 Steffen L M, Folsom A R, Cushman M, Jacobs Jr D R, Rosamond W D. Greater fish, fruit, and vegetable intakes are related to lower incidence of venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology.  Circulation. 2007;  115 (2) 188-195

Margaret A. Allman-Farinelli, Ph.D. , M.Phil.P.H. 

Associate Professor in Nutrition and Dietetics, School of Molecular Bioscience

University of Sydney, NSW 2006, Australia