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.
J Thromb Haemost. 2012 Aug;10(8):1547-55. doi: 10.1111/j.1538-7836.2012.04801.x.
Psychological distress might affect the international normalized ratio (INR), but effects might vary depending on oral anticoagulant (OAC) therapy.
To investigate the association of psychological distress with INR and clotting factors of the extrinsic pathway in patients with and without OAC therapy.
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.
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.
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.
心理困扰可能会影响国际标准化比值（INR），但影响可能因口服抗凝剂（OAC）治疗而异。
研究心理困扰与接受和未接受 OAC 治疗的患者 INR 和外源性凝血途径凝血因子之间的关系。
我们研究了 190 例有既往静脉血栓栓塞症（VTE）的患者；148 例已停止 OAC 治疗，42 例正在接受 OAC 治疗。为了评估心理困扰，所有患者都完成了经过验证的问卷，以测量抑郁、焦虑、担忧、愤怒和敌意的症状。INR、纤维蛋白原、因子（F）II:C、FV:C、FVII:C 和 FX:C 作为门诊血栓形成倾向检查的一部分进行测量。
在未接受 OAC 治疗的 VTE 患者中，与 INR<1.00 的比值相比，抑郁、焦虑、担忧和愤怒症状每增加一个标准差（SD），INR 降低的几率分别增加 1.5 至 1.8 倍，调整性别、年龄、体重指数、社会经济地位、红细胞压积和 C 反应蛋白后。担忧、愤怒和敌意也与 FVII:C 呈显著直接相关。在接受 OAC 治疗的患者中，INR 与负性情绪无关；然而，与未接受 OAC 治疗的患者相比，接受 OAC 治疗的患者中较低的 FVII:C 与焦虑和担忧相关，较低的 FX:C 与愤怒和敌意相关。
在未接受 OAC 治疗的 VTE 患者中，心理困扰与 INR 降低有关。心理困扰与外源性凝血途径某些凝血因子活性之间的关联方向可能因 VTE 患者是否接受 OAC 治疗而有所不同。
