Effects of psychological stress and psychiatric disorders on blood coagulation and fibrinolysis: A biobehavioral pathway to coronary artery disease?

Objective: A hypercoagulable state before overt thrombosis resulting from a n imbalance between the coagulation and fibrinolysis systems is related to cardiovascular disease progression and acute coronary syndromes. Psychologi cal stressors and depressive and anxiety disorders also are associated with coronary artery disease. This review explores whether changes in blood coa gulation. anticoagulant, and fibrinolytic activity may constitute psychobio logical pathways that link psychological factors with coronary syndromes. M ethods: Literature on coagulation, anticoagulation, and fibrinolysis measur es in conjunction with psychological factors (mental stress, psychosocial s train, and psychiatric disorders) was identified by MEDLINE search back to 1966 and through checking the bibliographies of these sources. Sixty-eight articles were critically reviewed. Results: In healthy subjects, acute ment al stress simultaneously activates coagulation (ie, fibrinogen or von Wille brand factor) and fibrinolysis (ie, tissue-type plasminogen activator) with in a physiological range. In patients with atherosclerosis and impaired end othelial anticoagulant function, however, procoagulant responses to acute s tressors may outweigh anticoagulant mechanisms and thereby promote a hyperc oagulable state. Chronic psychosocial stressors (job strain or low socioeco nomic status) are related to a hypercoagulable state reflected by increased procoagulant molecules (ie, fibrinogen or coagulation factor VII) and by r educed fibrinolytic capacity. There is also some evidence that points to hy percoagulability in depression. Conclusions: Different categories of psycho logical measures to varying extent are associated with characteristic patte rns of coagulation and fibrinolysis activity. Associations between psycholo gical factors and several coagulation and fibrinolysis variables related to atherosclerosis provide a plausible biobehavioral link to coronary artery disease.