Markers of thrombogenesis are activated in unmedicated patients with acute psychosis: a matched case control study

Abstract

BackgroundAntipsychotic treatment has been repeatedly found to be associated with an increased risk for venous thromboembolism in schizophrenia. The extent to which the propensity for venous thromboembolism is linked to antipsychotic medication alone or psychosis itself is unclear. The objective of this study was to determine whether markers of thrombogenesis are increased in psychotic patients who have not yet been treated with antipsychotic medication.MethodsWe investigated the plasma levels of markers indicating activation of coagulation (D-dimers and Factor VIII) and platelets (soluble P-selectin, sP-selectin) in an antipsychotic-naive group of fourteen men and eleven women with acute psychosis (age 29.1 ± 8.3 years, body mass index 23.6 ± 4.7), and twenty-five healthy volunteers were matched for age, gender and body mass index.ResultsD-dimers (median 0.38 versus 0.19 mg/l, mean 1.12 ± 2.38 versus 0.28 ± 0.3 mg/l; P = 0.003) and sP-selectin (median 204.1 versus 112.4 ng/ml, mean 209.9 ± 124 versus 124.1 ± 32; P = 0.0005) plasma levels were significantly increased in the group of patients with acute psychosis as compared with healthy volunteers. We found a trend (median 148% versus 110%, mean 160 ± 72.5 versus 123 ± 62.5; P = 0.062) of increased plasma levels of factor VIII in psychotic patients as compared with healthy volunteers.ConclusionsThe results suggest that at least a part of venous thromboembolic events in patients with acute psychosis may be induced by pathogenic mechanisms related to psychosis rather than by antipsychotic treatment. Finding an exact cause for venous thromboembolism in psychotic patients is necessary for its effective treatment and prevention.

Fatal pulmonary thromboembolism after prolonged physical immobilization in hospitalized psychiatric patients

“…The mentioned study 15 confirms the presence of higher markers of thrombogenesis in plasma of acute psychotic patients compared to healthy persons (D-dimer, factor VIII as well as soluble P-selectin).…”

Neonatal levels of acute phase proteins and later risk of non-affective psychosis

“…Disturbances in blood coagulability, potentially contributing to the increased incidence of cardiovascular disease among patients with schizophrenia, have not only been associated with anti-psychotic medication use but have also been reported in medication-naive patients with psychosis. 54 …”

Is there a role for immune-to-brain communication in schizophrenia?

“…Studies comparing unmedicated, acutely unwell cases of schizophrenia defined by DSM-IV or ICD-10 criteria with healthy controls have reported increased soluble P (sP)-selectin, sL-selectin, D-dimer levels in serum as well as increased number of integrin α IIb β IIIa receptors on platelets in schizophrenia (Iwata et al 2007; Masopust et al 2011; Walsh et al 2002). These findings could not be explained by concurrent inflammation or physical illness (Masopust et al 2011). One study focusing on different selectin molecules found that serum sL-selectin was increased in schizophrenia even after controlling for lymphocyte count (Iwata et al 2007).…”