Momentary stress moderates procoagulant reactivity to a trauma-specific interview in patients with posttraumatic stress disorder caused by myocardial infarction

• Published in: Journal of psychiatric research 2010-10, Vol.44 (14), p.956-963
• Main Authors: von Känel, Roland, Abbas, Chiara C, Schmid, Jean-Paul, Saner, Hugo, Haeberli, André, Stutz, Monika, Begré, Stefan
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Anxiety disorders. Neuroses; Biological and medical sciences; Blood; Blood coagulation; Cardiology. Vascular system; Cardiovascular disease; Case-Control Studies; Coronary heart disease; Diagnostic and Statistical Manual of Mental Disorders; Female; Fibrin Fibrinogen Degradation Products - immunology; Fibrinogen; Fibrinogen - metabolism; Follow-Up Studies; Heart; Humans; Indexing in process; Interview, Psychological; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - psychology; Myocarditis. Cardiomyopathies; Post-traumatic stress disorder; Posttraumatic stress disorder; Psychiatry; Psychological stress; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reactivity; Risk Factors; Severity of Illness Index; Stress; Stress Disorders, Post-Traumatic - blood; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - etiology; Stress Disorders, Post-Traumatic - psychology; Stress, Psychological - blood; Stress, Psychological - etiology; Surveys and Questionnaires
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2010.03.004

Abstract Hypercoagulability of the blood might partially explain the increased cardiovascular disease risk in posttraumatic stress disorder (PTSD) and is also triggered by anticipatory stress. We hypothesized exaggerated procoagulant reactivity in patients with PTSD in response to a trauma-specific interview that would be moderated by momentary stress levels. We examined 23 patients with interviewer-diagnosed PTSD caused by myocardial infarction (MI) and 21 post-MI patients without PTSD. A second diagnostic (i.e., trauma-specific) interview to assess posttraumatic stress severity was performed after a median follow-up of 26 months (range 12–36). Before that interview patients rated levels of momentary stress (Likert scale 0–10) and had blood collected before and after the interview. The interaction between PTSD diagnostic status at study entry and level of momentary stress before the follow-up interview predicted reactivity of fibrinogen ( P = 0.036) and d -dimer ( P = 0.002) to the PTSD interview. Among patients with high momentary stress levels, PTSD patients had greater fibrinogen ( P = 0.023) and d -dimer ( P = 0.035) reactivity than non-PTSD patients. Among patients with low momentary stress levels, PTSD patients had less d -dimer reactivity than non-PTSD patients ( P = 0.024); fibrinogen reactivity did not significantly differ between groups. Momentary stress levels, but not severity of posttraumatic stress, correlated with d -dimer reactivity in PTSD patients ( r = 0.46, P = 0.029). We conclude that momentary stress levels moderated the relationship between PTSD and procoagulant reactivity to a trauma-specific interview. Procoagulant reactivity in post-MI patients with PTSD confronted with their traumatically experienced MI was observed if patients perceived high levels of momentary stress before the interview.