La Rosa Federica, Montecucco Fabrizio, Liberale Luca, Sessarego Marta, Carbone Federico
First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 Viale Benedetto XV, 16132, Genoa, Italy.
IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy.
Intern Emerg Med. 2025 Jan;20(1):47-64. doi: 10.1007/s11739-024-03765-7. Epub 2024 Sep 13.
Weight bias and stigma have limited the awareness of the systemic consequences related to obesity. As the narrative evolves, obesity is emerging as a driver and enhancer of many pathological conditions. Among these, the risk of venous thromboembolism (VTE) is a critical concern linked to obesity, ranking as the third most common cardiovascular condition. Obesity is recognized as a multifactorial risk factor for VTE, influenced by genetic, demographic, behavioral, and socio-economic conditions. Despite established links, the exact incidence of obesity related VTE in the general population remains largely unknown. The complexity of distinguishing between provoked and unprovoked VTE, coupled with gaps in obesity definition and assessment still complicates a tailored risk assessment of VTE risk. Obesity reactivity, hypercoagulability, and endothelial dysfunction are driven by the so-called 'adiposopathy'. This state of chronic inflammation and metabolic disturbance amplifies thrombin generation and alters endothelial function, promoting a pro-thrombotic environment. Additionally, the inflammation-induced clot formation-also referred to as 'immunothrombosis' further exacerbates VTE risk in people living with obesity. Furthermore, current evidence highlights significant gaps in the management of obesity related VTE, particularly concerning prophylaxis and treatment efficacy of anticoagulants in people living with obesity. This review underscores the need for tailored therapeutic approaches and well-designed clinical trials to address the unique challenges posed by obesity in VTE prevention and management. Advanced research and innovative strategies are imperative to improve outcomes and reduce the burden of VTE in people living with obesity.
体重偏见和污名化限制了人们对肥胖相关系统性后果的认识。随着认知的不断发展，肥胖正成为许多病理状况的驱动因素和加剧因素。其中，静脉血栓栓塞症（VTE）的风险是与肥胖相关的一个关键问题，是第三常见的心血管疾病。肥胖被认为是VTE的一个多因素风险因素，受到遗传、人口统计学、行为和社会经济状况的影响。尽管存在既定联系，但普通人群中肥胖相关VTE的确切发病率在很大程度上仍不为人知。区分诱因性和非诱因性VTE的复杂性，再加上肥胖定义和评估方面的差距，仍然使VTE风险的针对性评估变得复杂。肥胖反应性、高凝状态和内皮功能障碍是由所谓的“脂肪病”驱动的。这种慢性炎症和代谢紊乱状态会放大凝血酶的生成并改变内皮功能，促进血栓前状态。此外，炎症诱导的血栓形成——也称为“免疫血栓形成”——进一步加剧了肥胖人群的VTE风险。此外，目前的证据凸显了肥胖相关VTE管理方面的重大差距，特别是在肥胖人群中抗凝剂的预防和治疗效果方面。这篇综述强调了需要采用针对性的治疗方法和精心设计的临床试验，以应对肥胖在VTE预防和管理中带来的独特挑战。先进的研究和创新策略对于改善肥胖人群的治疗结果和减轻VTE负担至关重要。
