Relation of psychological distress to the international normalized ratio in patients with venous thromboembolism with and without oral anticoagulant therapy.
BACKGROUND
Psychological distress might affect the international normalized ratio (INR), but effects might vary depending on oral anticoagulant (OAC) therapy.


OBJECTIVE
To investigate the association of psychological distress with INR and clotting factors of the extrinsic pathway in patients with and without OAC therapy.


METHODS
We studied 190 patients with a previous venous thromboembolism (VTE); 148 had discontinued OAC therapy and 42 had ongoing OAC therapy. To assess psychological distress, all patients completed validated questionnaires to measure symptoms of depression, anxiety, worrying, anger and hostility. INR, fibrinogen, factor (F)II:C, FV:C, FVII:C and FX:C were measured as part of outpatient thrombophilia work-up.


RESULTS
In VTE patients without OAC therapy, the odds of a reduced INR (< 1.00) were significantly increased from 1.5 to 1.8 times for an increase of 1 standard deviation (SD) in symptoms of depression, anxiety, worrying and anger, respectively, after adjusting for gender, age, body mass index, socioeconomic status, hematocrit and C-reactive protein. Worrying, anger and hostility also showed significant direct associations with FVII:C. In patients with OAC therapy, INR was unrelated to a negative affect; however, lower FVII:C related to anxiety and worrying as well as lower FX:C related to anger and hostility were observed in patients with OAC therapy compared with those without OAC therapy.


CONCLUSIONS
Psychological distress was associated with a reduced INR in VTE patients without OAC therapy. The direction of the association between psychological distress and activity in some clotting factors of the extrinsic coagulation pathway might differ depending on whether VTE patients are under OAC therapy or not.
Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern Department of Clinical Research, University of Bern, Bern, Switzerland. roland.vonkaenel@insel.ch
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Von Känel
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Vökt
F Demarmels
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Biasiutti
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Stauber
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Wuillemin
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PS
Lukas
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000786:Anger; D000925:Anticoagulants / Q000008:administration & dosage*; D001007:Anxiety / Q000150:complications; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects*; D016009:Chi-Square Distribution; D003863:Depression / Q000150:complications; D005260:Female; D006791:Hostility; D006801:Humans; D019934:International Normalized Ratio; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000097:blood / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D013557:Switzerland; D054556:Venous Thromboembolism / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D055815:Young Adult
D000925:Anticoagulants; D015415:Biomarkers