Abstract
Anxiety, a normal response to stressful situations, is characterized by increased
levels of factor VIII, fibrinogen, and von Willebrand factor, and by enhanced platelet
aggregability. One would expect acute anxiety to be a prothrombotic state, but since
acute mental stress induces tissue plasminogen activator (tPA) release from endothelial
and chromaffin cells, fibrinolysis counteracts procoagulant stimuli. It could be said
that procoagulant changes accompanying the fight-or-flight response reduce the risk
of bleeding in case of potential injuries, while activation of fibrinolysis counteracts
activation of hemostasis to prevent intravascular thrombus formation before injuries
occur. Acutely anxious patients are prone to bleeding or thrombosis when the balance
between hypercoagulation and hyperfibrinolysis is disturbed. Acute anxiety not only
increases the risk of bleeding in hemophilia or von Willebrand disease, but many reports
have shown that anxiolytic interventions such as hypnosis are effective in controlling
bleeding in hemostatic disorders. The pathogenesis of cardiovascular and thrombotic
diseases in highly anxious patients is multifactorial. An important element is α-adrenergic
vasoconstriction, which increases viscosity due to leakage of intravascular fluid
into the interstitium, and also causes hypertension, favoring plaque rupture. Paradoxical
as it may seem, over secretion of tPA may increase cardiovascular risk. This is because
tPA degrades the extracellular matrix, causing vascular stiffness that increases cardiac
workload, and thus oxygen requirements. Anxious patients with conditions associated
with increased plasminogen activator inhibitor-1 levels, such as depression or postprandial
hyperinsulinemia, are at high risk of thrombosis. Postprandial hyperinsulinemia may
result from consumption of high-carbohydrate foods, considered anxiolytic, combined
with a sedentary life, which is common among anxious individuals. Preliminary evidence
suggests that high anxiety combined with either depression or a lifestyle that results
in hyperinsulinemia has an important role in the pathogenesis of thrombotic events
currently classified as unprovoked.
Keywords
anxiety - bleeding - depression - diet - sedentary - thromboembolism
