Relationship between stress and activation of the coagulation system

Dvadesetčetirisatna dežurstva predstavljaju jedan od većih stresora za liječnike jer osim umora i poremećaja cirkadijarnog ritma uključuju odgovornost u donošenju odluka i rad s pacijentima koji nisu uvijek suradljivi. Poznato je da stres na radnom mjestu dovodi do aktivacije koagulacijskog sustava, a nastalo hiperkoagulabilno stanje pogoduje razvoju kardiovaskularnih oštećenja. Cilj ovog rada bio je ispitati utjecaj dvadesetčetirisatnog dežurstva na globalne koagulacijske pretrage: PV, APTV i TV te na koncentraciju fibrinogena i vrijeme fibrinolize. U istraživanju je sudjelovalo 29 liječnika na specijalističkom usavršavanju. Liječnicima je krv uzeta tri puta: prije, tijekom i nakon dežurstva. Rezultati su pokazali da nije došlo do značajne aktivacije koagulacijskog sustava koja bi se odrazila na globalne pretrage i koncentraciju fibrinogena. Međutim, pokazalo se da je vrijeme fibrinolize dobiveno euglobulinskim testom produženo u dva jutarnja mjerenja u odnosu na mijerenje tijekom dežurstva u večernjim satima. Nije jasno u kojoj je mjeri navedena promjena uzrokovana stresnim dežurstvom, a u kojoj fiziološkim oscilacijama u aktivaciji fibrinolize.24-h work shifts are known to be one of the major stressors for physicians because of the circadian rhythm disruption and tiredness. Besides that, they include responsibility in making decisions and working with patients who are not always cooperative. Studies have shown that work stress leads to the activation of the coagulation system, and that the resulting hypercoagulable state favors the development of cardiovascular damage. The aim of this study was to examine the effects of a 24-h work shift on global coagulation parameters: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT), but also the fibrinogen concentration and fibrinolysis time. The study group included 29 physicians on education. The blood was sampled three times: before, during and after the work shift. Our results have shown that there was no coagulation system activation that would affect global tests and fibrinogen concentration. However, fibrinolysis time obtained with the euglobulin test was extended in two morning measurements compared to the evening measurement. It is not clear if this is caused by work stress or the physiologic oscillations in fibrinolysis