title: Differential effects of oral and transdermal estrogen/progesterone regimens on sensitivity to activated protein C among postmenopausal women: a randomized trial.
abstract: OBJECTIVE
  Activated protein C (APC) resistance not related to the factor V Leiden mutation is a risk factor for venous thrombosis. Oral estrogen replacement therapy (ERT) has been reported to induce APC resistance. Little is known about the effect of transdermal estrogen.
  
  
  RESULTS
  We enrolled 196 postmenopausal women who were randomly allocated to receive either 1 mg 17beta-estradiol orally (n=63) or 50 microg 17beta-estradiol transdermally per day (n=68), both associated with 100 mg progesterone daily or placebo (n=65) for 6 months. An activated partial thromboplastin time (APTT)-based test and the effect of APC on thrombin potential (ETP) were used. Oral ERT induced an ETP-based APC resistance compared with both placebo (P=0.006) and transdermal ERT (P<0.001), but there was no significant effect of transdermal ERT compared with placebo (P=0.191). There was no significant effect of ERT on the APTT-based APC sensitivity ratio. Prothrombin fragment 1+2 plasma levels were significantly higher after 6 months of treatment in women allocated to oral ERT compared with those on placebo and transdermal ERT and were positively and significantly correlated with changes in ETP-based APC sensitivity ratio.
  
  
  CONCLUSIONS
  Our data show that oral, unlike transdermal, estrogen induces APC resistance and activates blood coagulation. These results emphasize the importance of the route of estrogen administration.
authors.affiliation: Département de Médecine Interne, Hôpital de la Cavale Blanche, Brest, France. emmanual.oger@southernhealth.org.au
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.forename: Martine
authors.initials: M
authors.lastname: Alhenc-Gelas
authors.forename: Karine
authors.initials: K
authors.lastname: Lacut
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Blouch
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roudaut
authors.forename: Véronique
authors.initials: V
authors.lastname: Kerlan
authors.forename: Michel
authors.initials: M
authors.lastname: Collet
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Abgrall
authors.forename: Martine
authors.initials: M
authors.lastname: Aiach
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Scarabin
authors.forename: Dominique
authors.initials: D
authors.lastname: Mottier
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D004967:Estrogens / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017698:Postmenopause / Q000502:physiology*; D011374:Progesterone / Q000008:administration & dosage* / Q000627:therapeutic use; D011486:Protein C / Q000378:metabolism*
chemical_list: D004967:Estrogens; D011486:Protein C; D011374:Progesterone