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von Känel R. Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration. Semin Thromb Hemost 2024. [PMID: 38914118 DOI: 10.1055/s-0044-1787660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Ingemann-Molden S, Caspersen CK, Rolving N, Højen AA, Klok FA, Grove EL, Brocki BC, Andreasen J. Comparison of important factors to patients recovering from pulmonary embolism and items covered in patient-reported outcome measures: A mixed-methods systematic review. Thromb Res 2024; 233:69-81. [PMID: 38029548 DOI: 10.1016/j.thromres.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Up to 50 % of patients recovering from pulmonary embolism (PE) experience negative long-term outcomes. Patient-reported outcome measures (PROMs) are important in identifying what matters to patients. We aimed to identify PROMs used in clinical studies and recommended by the International Consortium of Health Outcomes (ICHOM) and compare individual items with factors considered important by patients recovering from PE. METHODS This was a convergent mixed-methods systematic review, including quantitative studies, using PROMs and qualitative studies with non-cancer-related PE patients. Items from each PROM and qualitative findings were categorised using an International Classification of Function linking process to allow for integrated synthesis. RESULTS A total of 68 studies using 34 different PROMs with 657 items and 13 qualitative studies with 408 findings were included. A total of 104 individual ICF codes were used, and subsequently sorted into 20 distinct categories representing patient concerns. Identified PROMs were found to adequately cover 17/20 categories, including anxiety, fear of bleeding, stress, depression, dizziness/nausea, sleep disturbance, pain, dyspnea, fatigue, activity levels, family and friends, socializing, outlook on life, and medical treatment. PROMs from the ICHOM core set covered the same categories, except for dizziness/nausea. CONCLUSIONS No single PROM covered all aspects assessed as important by the PE population. PROMs recommended in the ICHOM core set cover 16/20 aspects. However, worrisome thoughts, hypervigilance around symptoms, and uncertainty of illness were experienced by patients with PE but were not covered by PROMS.
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Affiliation(s)
- Stian Ingemann-Molden
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Nanna Rolving
- Department of Physical and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anette Arbjerg Højen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University Hospital and Aalborg University, Aalborg, Denmark
| | - Frederikus A Klok
- Department of Medicine, Thrombosis and Haemostasis Leiden University Medical Centre, Leiden, the Netherlands
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark
| | - Barbara Cristina Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Aalborg Health and Rehabilitation Centre, Aalborg Municipality, Aalborg, Denmark
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Relationship Between Haemostasis Parameters and Anxiety Under Examination Stress: A Pilot Study. Indian J Hematol Blood Transfus 2018; 34:727-730. [PMID: 30369749 DOI: 10.1007/s12288-018-0980-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
This work aims to clarify how blood coagulation parameters reflect mild stress response in males and females. Healthy student volunteers of both sexes were used in this pilot study. A new global sensitive assay of haemostasis, spatial thrombodynamics, along with conventional coagulometry approach were used to evaluate of blood coagulation parameters. Psychodiagnostics scales (according to Spielberger and Taylor) are employed to evaluate anxiety as stress-induced response. We have selected exam stress, which despite being a mild stressor may nevertheless cause somatic disorders. We provide the first evidence of a statistically significant increase in initial clot growth velocity in women, but not men, in response to exam stress. The exam situation produces higher situational anxiety in female volunteers, and so they express remarkable stress-induced haemostatic responses, including plasma- and platelet-based changes. In contrast, male volunteers do not express pronounced stress-induced changes in haemostasis, and only display a decrease in plateletcrit value and an increase in prothrombin time. Mild form of stress (exam) induces changes in some blood coagulation parameters. A statistically significant remarkable increase in Vinit value and some other plasma- and platelet-based parameters has been seen in female students (but not male ones) under exam stress.
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Galli F, Borghi L, Faioni E, Cavicchioli M, Ferrari Losi J, Vegni E. Failure of the Anticoagulant Therapy and Psychological Distress: Still Far From a Bridge. Front Psychol 2018; 9:1709. [PMID: 30271365 PMCID: PMC6146033 DOI: 10.3389/fpsyg.2018.01709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/23/2018] [Indexed: 12/03/2022] Open
Abstract
Background: The procoagulant stress response reflects part of a beneficial adaptation of the organism to environmental threats, but a protracted procoagulant state generates a thrombotic risk. Atrial fibrillation (AF) is the most common arrhythmia in the general population. Patients with AF have a higher risk of thromboembolic events and stroke, therefore they are treated with long-term oral anticoagulant (OAC) therapy. The aim of this study is to evaluate if there is any association between psychological distress and clinically unexplained variations of the International Normalized Ratio (INR), that is the index used to monitor both thromboembolic and bleeding risk in the case of patients under OAC therapy. Methods: Fifty-eight patients (men = 27; women = 31; mean age = 74.98) were recruited. The sample was divided according to the recognition (or not) of the reason why the INR was subtherapeutic (<2) and classified as “Known Reasons” (KR = 32.8%) and “Unknown Reasons” (UR = 67.2%). Psychological assessment included the following dimensions: symptoms of anxiety and depression, perceived stress, emotional regulation strategies, and alexithymia. Results: Considering Mann–Whitney test results, no significant difference was found in the scores of anxiety, depression, stress, and emotional regulation strategies. With regard to alexithymia, UR patients are characterized by a moderate tendency to an outward-oriented thinking (r = 0.25). Conclusion: A clear role for the detected psychological factors in determining abnormal INR range in patients under OAC therapy could not be found. Further studies are needed to support our findings, if possible exploring factors other than psychological distress and the related emotion regulation strategies.
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Affiliation(s)
- Federica Galli
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Lidia Borghi
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elena Faioni
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,SIMT, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marco Cavicchioli
- Department of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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von Känel R, Margani A, Stauber S, Meyer FA, Demarmels Biasiutti F, Vökt F, Wissmann T, Lämmle B, Lukas PS. Depressive symptoms as a novel risk factor for recurrent venous thromboembolism: a longitudinal observational study in patients referred for thrombophilia investigation. PLoS One 2015; 10:e0125858. [PMID: 25938663 PMCID: PMC4418654 DOI: 10.1371/journal.pone.0125858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/23/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Increasing evidence suggests that psychosocial factors, including depression predict incident venous thromboembolism (VTE) against a background of genetic and acquired risk factors. The role of psychosocial factors for the risk of recurrent VTE has not previously been examined. We hypothesized that depressive symptoms in patients with prior VTE are associated with an increased risk of recurrent VTE. METHODS In this longitudinal observational study, we investigated 271 consecutive patients, aged 18 years or older, referred for thrombophilia investigation with an objectively diagnosed episode of VTE. Patients completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). During the observation period, they were contacted by phone and information on recurrent VTE, anticoagulation therapy, and thromboprophylaxis in risk situations was collected. RESULTS Clinically relevant depressive symptoms (HADS-D score ≥ 8) were present in 10% of patients. During a median observation period of 13 months (range 5-48), 27 (10%) patients experienced recurrent VTE. After controlling for sociodemographic and clinical factors, a 3-point increase on the HADS-D score was associated with a 44% greater risk of recurrent VTE (OR 1.44, 95% CI 1.02, 2.06). Compared to patients with lower levels of depressive symptoms (HADS-D score: range 0-2), those with higher levels (HADS-D score: range 3-16) had a 4.1-times greater risk of recurrent VTE (OR 4.07, 95% CI 1.55, 10.66). CONCLUSIONS The findings suggest that depressive symptoms might contribute to an increased risk of recurrent VTE independent of other prognostic factors. An increased risk might already be present at subclinical levels of depressive symptoms.
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Affiliation(s)
- Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
- Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
- * E-mail:
| | - Angelina Margani
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Stefanie Stauber
- Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, and University of Bern, Bern Switzerland
| | - Fiorenza A. Meyer
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Franziska Demarmels Biasiutti
- University Clinic of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Franziska Vökt
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Thomas Wissmann
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Bernhard Lämmle
- University Clinic of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Paul S. Lukas
- Department of Clinical Research, University of Bern, Bern, Switzerland
- Privatklinik für Psychiatrie und Psychotherapie, Sanatorium Kilchberg, Kilchberg, Switzerland
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Delle Chiaie R, Capra E, Salviati M, Trabucchi G, Pancheri C, Corrado A, Biondi M. Persistence of subsyndromal residual symptoms after remission of major depression in patients without cardiovascular disease may condition maintenance of elevated platelet factor 4 and β-thromboglobulin plasma levels. J Affect Disord 2013; 150:664-7. [PMID: 23611535 DOI: 10.1016/j.jad.2013.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depressive patients show a state dependent platelet activation that may heighten their cardiovascular risk, specially when comorbid with Coronary Artery Disease (CAD). We still have little information however on the possibility that residual symptoms that often persist after recovery from a major depressive episode may contribute to drive forward platelet activation, thus extending the exposure to the associated cardiovascular risk. METHODS Nineteen major depressed inpatients treated with electroconvulsive therapy (ECT) were enrolled and tested for platelet aggregation by measuring platelet factor-4 (PF4) and β-thromboglobulin (β-TG) plasma levels, and for psychometric evaluation by using the 20-item Hamilton Depression Rating Scale (HDRS) and the Symptom Checklist 90 Revised (SCL-90R). Subjects were tested at the beginning of treatment (baseline) and after clinical remission (endpoint). RESULTS At baseline the patients showed high HDRS (31±6) and total SCL-90R (200±38) scores, followed by a significant decrease at endpoint. However, even if all patients showed full syndromal recovery, SCL-90R "Hostility" and "Psychoticism" subscores showed no significant reduction from baseline, indicating the persistence of subtle residual symptoms. Baseline PF4 and β-TG plasma levels were found remarkably higher and no significant reduction was observed at the endpoint. LIMITATIONS Small study population. No follow-up evaluation. CONCLUSIONS Despite of clinical remission obtained with ECT in patients with major depression, persistence of subsyndromal residual symptoms may contribute to maintain a condition of platelet hyperactivation at the endpoint, increasing their cardiovascular risk and making them more vulnerable to develop cardiovascular disease.
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Reply to letters from Fall and Bailey, and Muldoon. Psychosom Med 2013; 75:223-6. [PMID: 23401580 DOI: 10.1097/psy.0b013e318286f949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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