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Buchold, J.* ; Meyer, H.* ; Struck, M.F.* ; Kohli, S.* ; Mathew, A.* ; Mangova, G.* ; Surov, A.* ; Blüher, M. ; Isermann, B.* ; Zimmermann, S.*

Obesity-related coagulation activation in adolescents and children: A systematic review and meta-analysis.

Obes. Rev., DOI: 10.1111/obr.70137 (2026)
Publ. Version/Full Text Research data DOI
Open Access Hybrid
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Obesity is recognized as a prothrombotic condition, yet the extent of coagulation activation across biomarkers remains unclear. This meta-analysis evaluates the impact of obesity on parameters-D-dimer, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF), factor VIII (FVIII), and endogenous thrombin potential (ETP)-in children and adults. Methods: Sixty-four studies comprising 59,503 individuals were analyzed. Plasma biomarker levels were compared between non-obese and obese groups using standardized mean differences (SMDs), with subgroup analyses. Results: D-dimer was significantly elevated in adults with obesity (SMD 1.36, 95% CI 0.47-2.25, p = 0.003) and children with obesity (SMD 0.77, 95% CI 0.19-1.36, p = 0.009), indicating increased fibrin turnover. Fibrinogen levels were markedly higher in both adults (SMD 1.17, 95% CI 0.14-2.20, p = 0.03) and children (SMD 1.43, 95% CI 0.93-1.92, p < 0.0001). PAI-1 showed the most pronounced increase in adults (SMD 2.30, 95% CI 0.1.51-3.09, p < 0.0001) and children (SMD 3.54, 95% CI 1.65-5.43, p = 0.0002). FVIII levels were modestly elevated (SMD 0.52, 95% CI 0.10-0.94, p = 0.02), whereas vWF levels showed inconsistent changes. ETP was significantly higher in obesity, in children (SMD 1.06, 95% CI 0.24-1.88, p = 0.01) and adults (SMD 0.71, 95% CI 0.46-0.97, p < 0.0001). Gender-stratified data indicated higher PAI-1, fibrinogen, and ETP levels in females. Conclusion: Obesity is associated with increased coagulation activation, suggesting a prothrombotic shift. These findings support the need for age-and gender-specific research into obesity-related hemostatic alterations.
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Publication type Article: Journal article
Document type Review
Keywords coagulation activation; meta-analysis; obesity; systematic review; Human Adipose-tissue; Increased Cardiovascular Risk; Visceral Fat Accumulation; Tumor-necrosis-factor; C-reactive Protein; Thrombin Generation; Endothelial Dysfunction; Insulin-resistance; Inhibitor Type-1; Weight-loss
ISSN (print) / ISBN 1467-7881
e-ISSN 1467-789X
Journal Obesity Reviews
Publisher Wiley
Publishing Place Oxford
Reviewing status Peer reviewed
Institute(s) Helmholtz Institute for Metabolism, Obesity and Vascular Research (HI-MAG)
Grants CRC1423
Stiftung Pathobiochemie und Molekulare Diagnostik