Relation of psychological distress to the international normalized ratio in patients with venous thromboembolism with and without oral anticoagulant therapy
Article first published online: 14 AUG 2012
© 2012 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 10, Issue 8, pages 1547–1555, August 2012
How to Cite
VON KÄNEL, R., VÖKT, F., BIASIUTTI, F. D., STAUBER, S., WUILLEMIN, W. A. and LUKAS, P. S. (2012), Relation of psychological distress to the international normalized ratio in patients with venous thromboembolism with and without oral anticoagulant therapy. Journal of Thrombosis and Haemostasis, 10: 1547–1555. doi: 10.1111/j.1538-7836.2012.04801.x
- Issue published online: 14 AUG 2012
- Article first published online: 14 AUG 2012
- Accepted manuscript online: 30 MAY 2012 10:16AM EST
- Received 2 April 2012, accepted 20 May 2012
- blood coagulation;
- negative affectivity;
- psychological stress;
- risk factors;
- venous thromboembolism
Summary. Background: Psychological distress might affect the international normalized ratio (INR), but effects might vary depending on oral anticoagulant (OAC) therapy.
Objectives: To investigate the association of psychological distress with INR and clotting factors of the extrinsic pathway in patients with and without OAC therapy.
Patients and 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.