Top 10 Variables: Stress
Tuesday, April 29, 2008
PTINR.com Staff
We can't see it but it affects us all, stress is a variable in our lives that can impact our health
Unexpected drug interactions, poor patient compliance, and dietary changes commonly result in fluctuations of the international normalized ratio (INR). Stress, which occurs in all patients at some time or another, can also influence INR test results over time.
The human body responds to environmental changes such as temperature and illness. Stress can be brought on by a variety of physical conditions. Pain can induce stress on the body. Colds and flu can increase stress. Sleep loss can introduce fatigue, another form of stress. The body also reacts to adverse emotional conditions. Some stress is due to worry and concern, or significant loss. We worry both about things that can be changed, and those things that cannot be changed. The loss of a spouse or immediate family member is common for older patients, and associated life changes and grief are commonly stressful for the survivor.
Stress, whether due to physical or emotional pressures, has the potential to influence lifestyle and health. Loss of appetite is common for patients under stress, which can lead to potential dietary deficiencies. Such dietary deficiencies have been associated with changes in INR test results.1 Stress is included in this series primarily because of its role in influencing decreased appetite and/or a properly balanced diet.
Patients taking warfarin (Coumadin ®), who are otherwise within therapeutic range, sometimes can experience instability of their INR test results. When a patient’s dose has remained constant, and other medication use have been consistently taken as directed, stress and any resulting dietary deficiencies may be a possible reason for unexplained INR results.
Patients should carefully consider their physical and emotional status preceding an unusually high or low INR test result. If stress and its influences appear to have played a role, the patient should inform the healthcare provider.
References:
Bristol-Myers Squibb Company. (2007). Medication Guide for Coumadin Tablets and Coumadin for Injection [Package Insert]. Princeton, NJ: Bristol-Myers Squibb Company.