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Metabolic consequences of obesity on the hypercoagulable state of polycystic ovary syndrome

Moin, Abu Saleh Md; Sathyapalan, Thozhukat; Diboun, Ilhame; Elrayess, Mohamed A.; Butler, Alexandra E.; Atkin, Stephen L.


Abu Saleh Md Moin

Thozhukat Sathyapalan

Ilhame Diboun

Mohamed A. Elrayess

Alexandra E. Butler

Stephen L. Atkin


© 2021, The Author(s). Polycystic ovary syndrome (PCOS) women have a hypercoagulable state; however, whether this is intrinsically due to PCOS or, alternatively, a consequence of its metabolic complications is unclear. We determined plasma coagulation pathway protein levels in PCOS (n = 146) and control (n = 97) women recruited to a PCOS biobank. Circulating levels of a panel of 18 clotting pathway proteins were determined by Slow Off-rate Modified Aptamer-scan plasma protein measurement. Cohorts were age matched, though PCOS had elevated body mass index (p < 0.001), insulin (p < 0.001) and C-reactive protein (CRP) (p < 0.0001). Eight pro-coagulation proteins were elevated in PCOS: plasminogen activator inhibitor-1 (p < 0.0001), fibrinogen (p < 0.01), fibrinogen gamma chain (p < 0.0001), fibronectin (p < 0.01), von Willebrand factor (p < 0.05), D-dimer (p < 0.0001), P-selectin (p < 0.05), and plasma kallikrein (p < 0.001). However, two anticoagulant proteins, vitamin K-dependent protein-S (p < 0.0001) and heparin cofactor-II (p < 0.001) were elevated and prothrombin was decreased (p < 0.05). CRP, as a marker of inflammation, and insulin resistance (HOMA-IR) correlated with 11 and 6 of the clotting proteins, respectively (p < 0.05). When matched for BMI < 25 (16 PCOS, 53 controls) HOMA-IR remained elevated (p < 0.05) and heparin cofactor-II was increased (p < 0.05). In a multivariate analysis accounting for inflammation, insulin resistance and BMI, there was no correlation of PCOS with any of the coagulation proteins. The hypercoagulable state in PCOS is not intrinsic to the disease as it can be fully accounted for by BMI, inflammation and insulin resistance.


Moin, A. S. M., Sathyapalan, T., Diboun, I., Elrayess, M. A., Butler, A. E., & Atkin, S. L. (in press). Metabolic consequences of obesity on the hypercoagulable state of polycystic ovary syndrome. Scientific reports, 11(1),

Journal Article Type Article
Acceptance Date Feb 18, 2021
Online Publication Date Mar 5, 2021
Deposit Date May 12, 2021
Publicly Available Date May 13, 2021
Journal Scientific Reports
Print ISSN 2045-2322
Electronic ISSN 2045-2322
Publisher Nature Publishing Group
Peer Reviewed Peer Reviewed
Volume 11
Issue 1
Article Number 5320
Keywords Endocrine system and metabolic diseases; Endocrinology; Obesity; Pre-diabetes
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Copyright Statement
© The Author(s) 2021.
Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

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