Proposed mechanisms of thrombosis in obesity. Obesity causes a prothrombotic state driven by chronic inflammation, impaired fibrinolysis, and clinical factors such as immobility, obstructive sleep apnea, and heart failure. Adipokines and proinflammatory cytokines secreted by M1 macrophages within adipose tissue contribute to the upregulation of procoagulant factors such as tissue factor and plasminogen activator inhibitor-1 (PAI-1), leading to increased thrombin generation, enhanced platelet activation, and an increased risk of thrombosis.