title: Association between anxiety and factors of coagulation and fibrinolysis.
abstract: BACKGROUND
  Psychological stress and anxiety have been shown to produce an activation of coagulation and fibrinolysis. Resulting hypercoagulability is a risk factor for cardiovascular diseases, and could therefore contribute to an increased prevalence of coronary artery disease in anxiety patients. However, hemostasis function has not yet been studied in patients with clinically relevant anxiety disorders.
  
  
  METHODS
  A group of anxiety patients (panic disorder with agoraphobia or social phobia) and a healthy control group (each n = 29) completed some questionnaires [SCL-K9 (a short form of the SCL-90-R), State Trait Anxiety Inventory, ADS (general depression scale)], and had blood drawn after a 15-min rest period. To assess the reaction of the hemostatic system by global entities, sum scores were computed from parameters of coagulation and fibrinolysis (fibrinogen, FVII, FVIII, vWF, F1 + 2, TAT, D-dimer, alpha(2)-AP, PAP, tPA, PAI-1). Interfering variables, such as age, gender, alcohol consumption and smoking status, were controlled.
  
  
  RESULTS
  Anxiety patients scored higher in a composite hemostatic score and a sum score of fibrinolysis in comparison to the control group, with a predominant activation of inhibitors in fibrinolysis. However, the psychological variable with the closest association to hemostasis was not trait anxiety, but self-perceived worry about blood drawing before blood sampling was performed.
  
  
  CONCLUSIONS
  The coagulation and fibrinolysis system is activated in the direction of a hypercoagulable state in patients with severe phobic anxiety, triggered by fear of blood drawing. This could be one mediating factor for the increased risk of cardiovascular diseases in this population. Acute situational phobic anxiety should be monitored closely when studying the association between anxiety and hemostasis.
authors: Clinic for Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany. franziska.geiser@ukb.uni-bonn.de
authors: Franziska
authors: F
authors: Geiser
authors: Christian
authors: C
authors: Meier
authors: Ingo
authors: I
authors: Wegener
authors: Katrin
authors: K
authors: Imbierowicz
authors: Rupert
authors: R
authors: Conrad
authors: Reinhard
authors: R
authors: Liedtke
authors: Johannes
authors: J
authors: Oldenburg
authors: Ursula
authors: U
authors: Harbrecht
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D001008:Anxiety Disorders / Q000097:blood / Q000453:epidemiology / Q000523:psychology; D001778:Blood Coagulation Disorders / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000453:epidemiology; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors; D019851:Thrombophilia