In addition, obese patients could have increased adipocytokine-mediated activity of coagulation factors, decreased activity of the fibrinolytic system, adipocyte release of tissue factor, increased production of leptin (54, 55) and adiponectin, and production of plasminogen activator inhibitor-1 from adipocytes, all of which result in coagulopathy (56). This evidence concerns the gene SERPINE1 and blood coagulation disease.