VWF and endothelial dysfunction: Prolonged exposure to high levels of psychological stress is associated with chronic inflammation, endothelial dysfunction, platelet activation and aggregation, and autonomic dysregulation.33 Acute psychological stress may trigger qualitative changes in several procoagulant factors such as fibrinogen, factor XII, factor VII, factor VIII, von Willebrand factor, platelet activity, thrombin-antithrombin complexes, fibrin D-dimer, and tissue-type plasminogen activator.34 The resulting procoagulant activity outweighs the profibrinolytic response, promoting a hypercoagulable state.