Changes of Plasma Coagulation and Fibrinolysis in Response to Mental Stress

Summary

To study the effects of standardized mental stress (arithmetic and the Stroop color word test) on plasma coagulation and fibrinolysis, blood samples were obtained before, during, and after 20 minutes of mental stress from 10 healthy, non-smoking young males aged 22 to 30 years. Reactions were compared with those observed during physical exercise and infusion of adrenaline. Both von Willebrand factor antigen and factor VIII coagulant activity increased significantly in response to mental stress (95 ± 28 vs 123 + 56%; p <0.05 and 125 ±54 vs 217 ± 170%; p <0.05, respectively). There was also a significant increase of factor VII coagulant activity (86 ± 31 vs 108 + 51%; p <0.05). Furthermore, mental stress caused an activation of the fibrinolytic system with an elevation of tissue plasminogen activator activity and tissue plasminogen activator antigen (0.80 ± 0.48 vs 1.23 ± 0.96 IU/ml; p = 0.076 and 4.38 ± 1.87 vs 5.78 ± 2.58 IU/ml; p <0.01). Fibrinogen concentration increased during stress (1.95 ± 0.29 vs 2.11 ± 0.27 g/1; p <0.05). Similar but more pronounced responses were observed during exercise and adrenaline infusion. Parallel to the increases in coagulation and fibrinolytic factors there were significant increases in heart rate, and systolic and diastolic blood pressure. It is concluded that mental stress has significant effects on plasma coagulation and fibrinolysis, and that it could thus affect important risk factors for cardiovascular disease.

Keywords

Mental stress - Psychosocial factors - Blood coagulation factors - Fibrinolysis

• References

• 1 Trichopoulus D, Katsouyanni K, Zavitsanos X, Tzonou A, Dalla-Vorgia P. Psychological stress and fatal heart attack: the Athens (1981) earthquake natural experiment. Lancet 1983; I: 441-444
• 2 Wolf S. Psychosocial forces in myocardial infarction and sudden death. Circulation 1969; 40 suppl (Suppl. 04) 74-83
• 3 Matthews KA, Haynes SG. Type A behavior pattern and coronary disease risk: Update and critical evaluation. Am J Epidemiol 1986; 123: 923-960
• 4 Clarkson TB, Kaplan JR, Adams MR, Manuck SB. Psychosocial influences on the pathogenesis of atherosclerosis among nonhuman primates. Circulation 1987; 76 (suppl I) 1-29
• 5 Mead TW. Epidemiology of atheroma, thrombosis and ischaemic heart disease. In: Haemostasis and Thrombosis. Bloom AL, Thomas DP. (eds) Churchill Livingstone; New York: 1987: 697-720
• 6 Ross R. The pathogenesis of atherosclerosis - an update. N Engl J Med 1986; 314 (08) 488-500
• 7 Jern C, Wadenvik H, Mark H, Hallgren J, Jern S. Haematological changes during acute mental stress. Br J Haematol 1989; 71: 153-156
• 8 Jern S. Psychological and hemodynamic factors in borderline hypertension. Acta Med Scand. 1982. Suppl 662
• 9 Eliasson K, Hjemdahl P, Kahan T. Circulatory and sympathoadrenal responses to stress in borderline and established hypertension. J Hypertension 1983; 1: 131-139
• 10 Vermylen C, de Vreker RA, Verstraete M. A rapid enzymatic method for assay of fibrinogen fibrin polymerization time (FPT test). Clin Chim Acta 1963; 8: 418-424
• 11 Ingerslev J. A sensitive ELISA for von Willebrand factor (vWf: Ag). Scand J Clin Lab Invest 1987; 47: 143-149
• 12 Eriksson E, Risberg B. Measurement of tissue plasminogen activator in plasma. A comparison of 3 methods and description of a new improved technique. Thromb Res 1987; 46: 213-223
• 13 Eriksson E, Ranby M, Gyzander E, Risberg B. Measurement of tissue plasminogen activator in plasma utilizing poly-lysine as a stimulator. Thromb Res 1988; 50: 91-101
• 14 Cannon WB, Gray H. Factors affecting the coagulation time of blood. II. The hastening or retarding of coagulation by adrenaline injections. Am J Physiol 1914; 34: 232-242
• 15 Ingram GI C. Increase in antihaemophilic globulin activity following infusion of adrenaline. J Physiol 1961; 156: 217-224
• 16 Rizza CR. Effect of exercise on the level of antihaemophilic globulin in human blood. J Physiol 1961; 156: 128-135
• 17 Schneider RA, Zangari VM. Variations in clotting time, relative viscosity, and other physiochemical properties of the blood accompanying physical and emotional stress in the normotensive and hypertensive subject. Psychosom Med 1951; 13: 289-303
• 18 Iatridis SG, Ferguson JH. Effect of physical exercise on blood clotting and fibrinolysis. J Appl Physiol 1963; 18: 337-344
• 19 Ingram GI C, Vaughan Jones R. The rise in clotting factor VIII induced in man by adrenaline: effect of alpha- and beta-blockers. J Physiol 1966; 187: 447-454
• 20 Cohen RJ, Epstein SE, Cohen LS, Dennis LH. Alterations of fibrinolysis and blood coagulation induced by exercise, and the role of beta-adrenergic-receptor stimulation. Lancet 1968; II: 1264-1266
• 21 Gunn CG, Hampton JW. CNS influence on plasma levels of factor VIII activity. Am J Physiol 1967; 212: 124-130
• 22 Jaffe EA, Hoyer LW, Nachman RL. Synthesis of antihemophilic factor antigen by cultured human endothelial cells. J Clin Invest 1973; 52: 2757-2764
• 23 Wall RT, Counts RB, Harker LA, Striker GE. Binding and release of factor VUI/von Willebrand factor by human endothelial cells. Br J Haematol 1980; 46: 287-298
• 24 Biggs R, Macfarlane RG, Pilling J. Observations on fibrinolysis. Experimental activity produced by exercise or adrenaline. Lancet 1947; I 252: 402-405
• 25 Truelove SC. Fibrinolysis and the eosinophil count. Clin Sci 1951; 10: 229-240
• 26 Cash JD, Allan AGE. The fibrinolytic response to moderate exercise and intravenous adrenaline in the same subjects. Br J Haematol 1967; 13: 376-383
• 27 Sawyer WD, Fletcher AP, Alkjaersig N, Sherry S. Studies on the thrombolytic activity of human plasma. J Clin Invest 1960; 39: 426-434
• 28 Sherry S, Lindemeyer RI, Fletcher AP, Alkjaersig N. Studies on enhanced fibrinolytic activity in man. J Clin Invest 1959; 38: 810-822
• 29 Cash JD, Woodfield DG, Allan AGE. Adrenergic mechanisms in the systemic plasminogen activator response to adrenaline in man. Br J Haematol 1970; 18: 487-494
• 30 Dembiriska-Kiec A, Kostka-Trabka E, Gryglewski RJ. Effect of prostacyclin on fibrinolytic activity in patients with arteriosclerosis obliterans. Thromb Haemostas 1982; 47 (02) 190
• 31 Cannon WB, Mendelhall WL. Factors affecting the coagulation time of blood. IV. The hastening of coagulation in pain and emotional excitement. Am J Physiol 1914; 34: 251-261
• 32 Selye H. The physiology and pathology of exposure to stress. Montreal Canada: Acta Inc Medical Publ; 1950
• 33 Ogston D, McDonald GA, Fullerton HW. The influence of anxiety in tests of blood coagulation and fibrinolytic activity. Lancet 1962; II: 521-523
• 34 Macfarlane RG, Biggs R. Observations on fibrinolysis. Spontaneous activity associated with surgical operations, trauma, etc. Lancet 1947; II: 862-864
• 35 Palmblad J, Blomback M, Egberg N, Froberg J, Karlsson CG, Levi L. Experimentally induced stress in man: effects on blood coagulation and fibrinolysis. J Psychosom Res 1977; 21: 87-92
• 36 Wilhelmsen L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med 1984; 311: 501-505
• 37 Levine S, Towell B, Suarez A, Knieriem L, Harris M, George J. Platelet activation and secretion associated with emotional stress. Circulation 1985; 71: 1129-1134
• 38 Hamsten A, Walldius G, Szamosi A. et al Plasminogen activator inhibitor in plasma: risk for recurrent myocardial infarction. Lancet 1987; II: 3-8
• 39 George JN, Nurden AT, Phillips DR. Molecular defects in interactions of platelets with the vessel wall. N Engl J Med 1984; 311: 1084-1098
• 40 Friedman RJ, Burns ER. Stress and induction of intravascular platelet aggregation in the heart. Circulation 1978; 48: 164-169