Hormone replacement therapy in healthy postmenopausal women: a randomized, placebo‐controlled study of effects on coagulation and fibrinolytic factors

Abstract

Gottsa Èter A, Rendell M, Hulthe Ân UL, Berntorp E, Mattiasson I (University of Lund, University Hospital, Malmo È, Sweden). Hormone replacement therapy in healthy postmenopausal women: a randomized, placebo-controlled study of effects on coagulation and ®brinolytic factors. J Intern Med 2001; 249: 237±246.

Assessment of hypercoagulability markers and lipid levels in postmenopausal women undergoing either oral or transdermal hormone replacement therapy

“…Samples collected before the beginning of HRT were used as controls. The period of 3 months was defined based on the fact that the incidence of VTE is higher in the first HRT year [6][7][8] and the majority of the studies report that levels of hypercoagulability markers are increased after 3-6 months of HRT [14][15][16][17][18][19].…”

“…Although HRT increases the risk for VTE, controversial results have been reported concerning the impact of HRT on the coagulation system, such as increased levels of procoagulant factors (VII, X, XII and XIII), decreased levels of natural anticoagulants (Antithrombin, protein C and protein S) or increased resistance to activated protein C (rPCa) [14][15][16][17]. Few studies have investigated the impact of HRT on hypercoagulability markers in the absence of genetic thrombophilic traits that may affect the generation of thrombin, such as mutation in FVL that results in resistance to activated protein C or prothrombin (PT) variant (G20210A), which results in hyperprothrombinemia, and the presence of C677T mutation in methylenetetrahydrofolate reductase (MTHFR) gene, that may result in hyperhomocysteinemia.…”

Variations in blood lipid profile, thrombotic system, arterial elasticity and psychosexual parameters in the cases of surgical and natural menopause

“…Hence, the studies have been carried out on possible changes in coagulation factors concentration and fibrinolytic activity during menopause and on the effects of hormone replacement therapy (HRT) over these changes. 5 A number of studies have been carried out assessing the effects of menopause on cardiovascular system. These studies were based on the both parameters of morphological and flow changes related to atherosclerosis detected by Doppler ultrasonography method.…”

Hormone replacement therapy and cardiovascular risk: do abnormalities of coagulation and fibrinolysis matter?

“…In the current issue of this journal, Gottsätter et al . [22] report a prospective, randomized, placebo‐controlled study of the coagulation or fibrinolytic effects by introducing HRT. They report that increased fibrinolysis (decrease of PAI‐1) as well as a prothrombotic effect (decrease in AT III and total protein S, increase in F VII) were particularly pronounced early (i.e.…”

“…The balance of coagulation and fibrinolysis appeared to be shifted towards a more prothrombotic state with unopposed oestrogen‐only HRT, although Gottsätter et al . [22] suggest that the addition of progesterone attenuated many of the changes.…”