Thrombosis and hormone replacement therapy in postmenopausal women.
OBJECTIVE
The effects of postmenopausal hormone replacement therapy on thrombosis remain controversial. We tested the hypothesis that estrogen or progesterone has no significant effect on thrombosis by means of newly developed markers of blood clotting, specifically prothrombin fragment 1 + 2, a marker of factor Xa generation, and thrombin-antithrombin III complex, a marker of thrombin generation.


METHODS
A prospective study that included 106 women, 68 postmenopausal women on hormone replacement therapy and 38 postmenopausal controls, was performed. Plasma levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex were measured by enzyme-linked immunosorbent assay. Multivariate analysis of the covariance was used for statistical analysis, controlling for patient's age because the hormone replacement therapy group was older.


RESULTS
There were no statistically significant differences between the hormone replacement therapy and control groups in either of the clotting parameters measured. A comparison of the levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex in patients receiving estrogen alone or estrogen plus progestin also revealed no differences.


CONCLUSIONS
Current doses of postmenopausal hormone replacement therapy do not appear to enhance in vivo clotting. Thromboembolic complications among postmenopausal women receiving hormone replacement therapy may therefore be secondary to congenital or other acquired coagulation defects.
Saleh
A A
AA
Department of Obstetrics and Gynecology, Grace Hospital, Detroit, MI 48235.
Dorey
L G
LG
Dombrowski
M P
MP
Ginsburg
K A
KA
Hirokawa
S
S
Kowalczyk
C
C
Hirata
J
J
Bottoms
S
S
Cotton
D B
DB
Mammen
E F
EF
D000328:Adult; D000990:Antithrombin III / Q000032:analysis*; D001777:Blood Coagulation / Q000187:drug effects*; D004958:Estradiol / Q000494:pharmacology / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D011516:Prothrombin / Q000032:analysis*; D013917:Thrombin / Q000032:analysis; D013927:Thrombosis / Q000139:chemically induced
D004966:Estrogens, Conjugated (USP); D004958:Estradiol; D000990:Antithrombin III; D011516:Prothrombin; D013917:Thrombin