Table 2

Platelet changes and acute stress.

Study / Sample / Mental Stressor(s) / Measures / Findings
Andrén et al., 1983 (1) / 10 healthy men / 10-minutes 100 dBA noise / PF4 / PF4 was unaffected by noise stress.
Fitchett et al., 1983 (2) / 12 patients with CHD; 7 healthy controls / Cold pressor / Arterial and venous βTG, platelet count / Venous βTG increased significantly in both groups during stress, but no change was observed in arterial βTG and platelet count.
Levine et al., 1985 (3) / 34 medical residents / Public speaking / PF4,βTG / PF4 levels were higher just prior to public speaking compared to baseline (11 months prior to speech) and recovery (5-21 days post-speech). βTG levels at stress were higher than baseline but not recovery.
Jern et al., 1989 (4) / 29 healthy young men / Mental arithmetic / Platelet count / Platelet count increased significantly from baseline to stress and returned to baseline levels after a 10-minute recovery period.
Larsson et al., 1989 (5) / 16 healthy men / Stroop / Ex vivo platelet aggregability, PF4, βTG / Aggregability increased during Stroop but there were no changes for PF4 or βTG.
Larsson et al., 1989 (6) / 9 healthy volunteers / Stroop / PDGF / PDGF increased during Stroop.
Larsson et al., 1990 (7) / 10 healthy men / Stroop / Ex vivo platelet aggregability / Aggregability was not affected by Stroop.
Rostrup et al., 1990 (8) / 29 mildly hypertensive men / Awareness of hypertension status, cold pressor / βTG / Baseline βTG was significantly higher among those who were informed of hypertension status than in those who were uninformed. βTG levels remained significantly higher in the informed group than the uninformed group during stress.
Grignani et al., 1991 (9) / 25 post-infarction patients; 10 healthy controls / Mental arithmetic / Platelet aggregation, platelet aggregate to ADP ratio, TXB2 / TXB2 and platelet aggregate to ADP ratio increased during stress in patients and controls.
Grignani et al., 1992 (10) / 10 post-infarction patients / Mental arithmetic / Platelet aggregation, platelet aggregate to ADP ratio, TXB2 / TXB2 and platelet aggregate to ADP ratio increased during stress.
Malkoff et al., 1993 (11) / 40 healthy men / Stroop / Platelet aggregation and secretion / Platelet secretion increased during stress but aggregation did not.
Naesh et al., 1993 (12) / 8 healthy men / Stroop / βTG, platelet concentration / βTG levels were not significantly higher during stress than at baseline, but were higher 30 and 60 minutes post-stress. Platelet concentration increased during stress, but correcting for hemoconcentration rendered this effect non-significant. However, the method for adjusting for hemoconcentration effects was not described.
Patterson et al., 1994 (13) / 55 healthy men / Mental arithmetic; Stroop; viewing surgery videos / PF4 / Compared to control participants, PF4 levels were higher in those who performed the stressors.
MundalRostrup, 1995 (14) / 26 healthy 19-year old males; Half of the sample was falsely informed of having elevated blood pressure / Mental arithmetic; cold pressor / βTG, platelet count, mean platelet volume / βTG levels increased significantly during the cold pressor in all participants, but the increase was significantly higher in the uninformed group. Platelet count and volume did not change.
Patterson et al., 1995 (15) / 27 healthy men / Mental arithmetic; cold pressor / PF4, βTG / PF4 and βTG levels increased during both stressors but to a greater extent during mental arithmetic.
Markovitz et al., 1996 (16) / 14 post-infarction patients; 15 healthy controls / Structured interview; speech task / βTG / βTG levels increased significantly in the control group but not in the post-infarction group.
Wallén et al., 1997 (17) / 103 angina patients; 50 healthy controls / Stroop / Ex vivo platelet aggregability, in vitro platelet aggregation, PF4, βTG / βTG levels increased significantly and PF4 levels increased marginally during stress among angina patients, whereas there was no change in βTG levels and PF4 levels decreased during stress among controls.
Tomoda et al., 1999 (18) / 24 patients with WHO stage I hypertension; 13 patients with stage 2 hypertension; 14 normotensive controls / Mental arithmetic / Platelet aggregation, βTG / In normotensives, aggregation and βTG did not change during stress. Both hypertensive groups showed increased aggregation and βTG during stress, but stage 1 had larger increases.
Wallén et al., 1999 (19) / 11 healthy men / Modified Stroop / Platelet-fibrinogen binding, ex vivo platelet aggregability, platelet count, platelet volume / Platelet-fibrinogen binding, platelet aggregability, platelet count and platelet volume were unaffected by the stressor.
Steptoe et al., 2003 (20) / 37 healthy men / Color/word interference task; mirror tracing / Total PLAs, PMAs, platelet-leukocyte aggregates, platelet-neutrophil aggregates / All aggregates increased immediately post-stress, but the highest levels were attained at 30 minutes post-stress. By 75 minutes post-stress, all aggregates returned to baseline levels.
Lederbogen et al., 2004 (21) / 9 depressed psychiatric inpatients; 10 age- and sex-matched controls / Computer-based detection task / Platelet count, P-selectin expression, GP53 expression / Platelet count and P-selectin expression significantly increased during stress in both groups, but GP53 expression did not. There were no group differences.
Strike et al., 2004 (22) / 17 male patients with CHD; 20 healthy age-matched controls / Color/word interference task; mirror tracing / Total PLAs / There were no differences between the two groups in PLAs at baseline and the increases in PLAs during stress. PLAs remained significantly elevated after 75 min recovery in the patients with CHD.
Sestito et al., 2005 (23) / 30 patients with syndrome X; 20 patients with unstable angina; 11 patients with stable angina; 22 controls / Mental arithmetic / Ex vivo platelet reactivity (adhesion and aggregability) / Platelet reactivity decreased among patients with syndrome X and increased among patients with stable angina. No change was observed for patients with unstable angina or for controls
Bacon et al., 2006 (24) / 72 patients with CHD (57 men, 15 women) / PASAT / Platelet count; PF4 / Neither platelet count nor PF4 changed.
Hamer et al., 2006 (25) / 91 healthy men / Speech task and mirror tracing, completed twice 4 weeks apart / Total PLAs, PMAs / PLAs and PMAs increased 10-min after the tasks in both sessions, but the overall levels of PLAs and PMAs decreased from session 1 to session 2. Blood was not drawn during or immediately after stress.
Aschbacher et al., 2009 (26) / 149 elderly individuals / Three 3-minute impromptu speeches one year apart / % platelet aggregates formed, % fibrinogen expression on platelet surfaces, % P-selectin expression / All markers of activation increased during stress with no habituation effects.
Reid et al., 2009 (27) / 249 patients with CHD / Mental arithmetic; anger recall / Six platelet activation marker sets including PLAs, βTG / Platelet activation marker sets increased significantly during stress, but βTG did not change.

Note. ADP, adenosine diphosphate, βTG, beta-thromboglobulin; PF4, platelet factor 4; PDGF, platelet-derived growth factor; PLA, platelet-leukocyte aggregate; PMA, platelet-monocyte aggregate; TXB2, thromboxane B2; WHO, World Health Organization

Table 3

Coagulation and acute stress.

Study / Sample / Mental Stressor(s) / Recovery Period / Measures / Findings
Jern et al., 1989 (4) / 10 healthy young men / Stroop; mental arithmetic / 10 min / Hct, Fib, FVII:C, FVII:ag, FVIII:C, vWF:ag / Hct, Fib, FVII:C, FVIII:C and vWf:ag increased significantly from baseline to stress. vWF:ag decreased significantly from stress to recovery, but Hct, Fib, FVII:C, and FVIII:C remained elevated. No effects for FVII:ag.
Jern et al., 1991 (28) / 9 healthy young women / Stroop; mental arithmetic / 10 min / Hct, Fib, FVII:ag, FVII:C, vWF:ag / Hct and Fib increased significantly from baseline to stress, but FVII:ag, FVII:C and vWF:ag did not. Recovery depended on menstrual cycle phase.
Muldoon et al., 1995 (29) / 44 healthy young adults / Stroop vs. control / None / Fib, Hct, Hgb, PV / The increase in Fib in stressed subjects was not significantly different compared to controls.
Davis, 1999 (30) / 52 healthy young female smokers and nonsmokers either taking or not taking oral contraceptives / Speech; mental arithmetic / 10 min / Fib, Hct / Fib increased significantly from baseline to stress across all women. Recovery measures not reported.
vonKänel et al., 2001 (31) / 53 elderly caregivers of patients with Alzheimer's disease (11 with and 42 without vascular disease) / Two speeches / None / D-dimer, vWF:ag / D-dimer increased significantly in those with vascular disease compared to those without vascular disease. No effects for vWF.
von Känel et al., 2002 (32) / 13 normotensive and 6 mildly hypertensive adults / Speech; mirror tracing / None / D-dimer / D-dimer increased significantly.
Steptoe et al., 2003 (33) / 221 middle-aged adults (125 men, 96 women) / Stroop; mirror tracing / 45 min / Hct, Fib / Hct and Fib increased significantly from baseline to stress and remained elevated after recovery.
Steptoe et al., 2003 (34) / 238 middle-aged adults (129 men, 109 women) / Stroop; mirror tracing / 45 min / Hct, PV, FVIII:C, vWF:ag,
D-dimer / Hct, FVIII:C and vWF:ag increased significantly from baseline to stress. After recovery, vWF:ag did not differ from baseline, but Hct and FVIII:C were still elevated. No effects for D-dimer.
vonKänel et al., 2004 (35) / 48 elderly adults (16 men, 32 women) / Two speeches / 14 min / D-dimer, vWF:ag / D-dimer increased significantly from baseline to stress and from stress to recovery. vWF:ag decreased significantly from baseline to sress.
von Känel et al., 2004 (36) / 24 healthy, middle-aged men / TSST, performed 3 times with one-week intervals; coagulation measured at weeks 1 and 3 / 45 min and 105 min / Fib, FVII:C, FVIII:C, FXII:C, APTT, PT, vWF:ag,
D-dimer / Fib, FVII:C, FVIII:C, FXI:a, and vWF:ag increased signficantly from baseline to stress and decreased significantly from stress to 45 min and 105 min recovery. D-dimer did not change from baseline to stress but significantly decreased from stress to 45 min recovery. No effects for APTT or PT. No habituation of responses from week 1 to week 3.
von Känel et al., 2005 (37) / 21 healthy men over age 35 / TSST / 45 min and 105 min / Fib,
D-dimer / Fib and D-dimer did not increase significantly from baseline to stress, but decreased significantly from stress to 45 min recovery.
Zgraggen et al., 2005 (38) / 22 healthy men over age 35 / TSST / None / Hct, Hgb, PV, Fib, FVII:C, FVIII:C, FXII:C, vWF:ag,
D-Dimer / Hct, Hgb, FVII:C, FVIII:C, FXII:C and vWF:ag increased significantly and PV decreased significantly from baseline to stress. Correlations between changes in Hct, Hgb, PV and changes in coagulation measures were not significant, with the exception of Hgb and FXII:C (r=.39).
Bacon et al., 2006 (24) / 72 patients with CHD (57 men, 15 women) / PASAT
/ 72 patients with CHD (57 men, 15 women) / PASAT / 20 min, followed by exercise / Fib / Fib did not increase significantly from baseline to stress.
Hamer et al., 2006 (25) / 91 healthy men / Speech; mirror tracing, completed twice 4 weeks apart / 10 min / vWF / In session 2 only, vWF increased significantly from baseline to 10 min recovery. Blood was not drawn during or immediately after stress.
Steptoe & Marmot, 2006 (39) / 228 middle-aged adults (125 men; 103 women) / Stroop; mirror tracing / 45 min / Fib, FVIII:C, vWF:ag / Fib, FVIII:C and vWF:ag increased significantly from baseline to stress. FVIII:C and vWF:ag returned to baseline levels during recovery, but Fib was still significantly higher at recovery compared to baseline.
Wirtz et al., 2006 (40) / 42 otherwise healthy men (17 hypertensive; 25 normotensive) / TSST / 20 min and 60 min / Fib, FVII:C, FVIII:C,
D-dimer / All factors increased significantly from baseline to stress and approached or returned to baseline levels by 60 min recovery.
Wirtz et al., 2006 (41) / 47 healthy men / TSST / 20 min and 60 min / D-dimer / D-dimer increased significantly from baseline to stress and 20 min recovery and returned to baseline levels at 60 min recovery.
de Boer et al., 2007 (42) / 22 young men / PASAT while watching themselves in a mirror / 30 min / Hct, APTT, PT / Hct increased with stress and returned to baseline at approximately 15 min recovery. PT shortened marginally with stress and returned to baseline at 8 min recovery. APTT did not show any effects.
Wirtz et al., 2007 (43) / 42 otherwise healthy men (17 hypertensive; 25 normotensive) / TSST / 60 min / Fib, FVII:C, FVIII:C,
D-dimer / Reanalysis of Wirtz et al. (2006b). Compared to those without diastolic hypertension, those with diastolic hypertension had higher levels of FVII:C and D-dimer immediately post-stress, higher levels of FVII:C, FVIII:C and D-dimer at 20 min recovery and higher FVIII:C at 60 min recovery.

Note. APTT, activated partial thromboplastin time; Fib, Fibrinogen; FVII:C, Factor VII coagulant activity; FVII:ag, Factor VII antigen; FVIII:C, Factor VIII coagulant activity; FXII:C, Factor XII coagulant activity; Hct, hematocrit; Hgb, hemoglobin; PASAT, paced auditory serial addition test; PT, prothrombin time; PV, plasma volume; TAT, thrombin-antithrombin III complex; TSST, Trier Social Stress Test; vWF:ag, von Willebrand factor antigen

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