These data are in accord with the association of heparin cofactor 2 with insulin resistance14, indicating that normal weight PCOS subjects likely have no additional risk associated with a hypercoagulable state; however, obesity with associated inflammation markedly exaggerates the hypercoagulable state with an increased number of clotting parameters altered. This evidence concerns the gene SERPIND1 and obesity due to melanocortin 4 receptor deficiency.