Obesity and Venous Thromboembolism: Mechanisms, Clinical Implications, and Prevention Strategies With a Focus on Bariatric Surgery

Abstract

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), constitutes a significant global health concern due to its substantial morbidity and mortality, especially among hospitalized and surgical individuals. DVT commonly presents in the lower extremities with symptoms such as calf pain, swelling potentially spreading to the ankle and foot, localized warmth, and skin discoloration. PTE, arising from acute pulmonary artery obstruction by a thrombus, frequently manifests as sudden dyspnea, chest pain, tachycardia, diaphoresis, hemoptysis, and lightheadedness, posing a life-threatening emergency demanding prompt medical intervention. Obesity stands out as a critical and modifiable risk factor for VTE, elevating its incidence in both the general population and during the perioperative period. Despite its efficacy in weight reduction, bariatric surgery markedly increases VTE risk, establishing it as a primary contributor to postoperative fatalities in surgical patients with obesity. The interplay between obesity and VTE involves a complex network of pathophysiological mechanisms and is further complicated by surgical and postoperative factors, necessitating comprehensive understanding and vigilant preventive strategies, especially within Asian populations, where specific anatomical and clinical factors may influence VTE risk profiles. This review comprehensively examines these pathophysiological links, clinical implications with a focus on bariatric surgery, and current prevention strategies, drawing insights from both Asian and Western guidelines and highlighting the evolving role of direct oral anticoagulants. (Copyright © 2025, The Korean Society for Metabolic and Bariatric Surgery.)