Effect of pulsed estrogen therapy on hemostatic markers in comparison with oral estrogen regimen in postmenopausal women.
OBJECTIVE
Hormone replacement therapy (HRT) is associated with an increased risk of thromboembolism dependent on the type of HRT; therefore, we compared therapy effects of intranasal with oral estrogens on coagulation and fibrinolysis markers in postmenopausal women.


METHODS
A randomized study in which 29 healthy hysterectomized women received intranasal 17beta-estradiol or oral estrogens for 3 months.


RESULTS
There were no significant differences in the baseline characteristics between groups. Those women receiving intranasal estradiol showed a mild increment in plasminogen activator inhibitor-1 (PAI-I) (from 6.8 +/- 3.5 to 9.6 +/- 3.9 U/ml, p < 0.01); however, fibrinogen, factor VII-tissue factor complex (VIIa-rTF), antithrombin III (ATIII), protein C (PC) activity, protein S (PS) activity, plasminogen (PLG), and tissue-type plasminogen activator antigen (t-PA) were unchanged. In contrast, oral unopposed estrogens elevated t-PA (from 4.9 +/- 2.9 to 9.6 +/- 5.1 ng/ml, p < 0.01) in parallel with a decrement in PAI-I (from 5.2 +/- 4.0 to 2.7 +/- 1.7 U/ml, p < 0.05) and VIIa-rTF (from 201.2 +/- 181.0 to 140.6 +/- 108.7 mU/ml, p < 0.05). Fibrinogen, ATIII, PC, PS, and PLG were unchanged.


CONCLUSIONS
Nasal 17beta-estradiol had no effect on the coagulation markers, except a moderate increment in PAI-1. In contrast, oral estrogens elicited a decrement in both VIIa-rTF and PAI-1; however, those changes did not surpass normal limits.
Basurto
Lourdes
L
Endocrine Research Unit, Nacional Medical Center, Instituto Mexicano del Seguro Social, México City, Mexico.
Saucedo
Renata
R
Zárate
Arturo
A
Martínez
Carlos
C
Gaminio
Elizabeth
E
Reyes
Elba
E
Hernandez
Marcelino
M
D000281:Administration, Intranasal; D000284:Administration, Oral; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000032:analysis* / Q000187:drug effects; D004958:Estradiol / Q000008:administration & dosage* / Q000494:pharmacology; D015914:Estrogen Replacement Therapy; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D017698:Postmenopause; D010959:Tissue Plasminogen Activator / Q000097:blood / Q000187:drug effects
D001779:Blood Coagulation Factors; D017395:Plasminogen Activator Inhibitor 1; D004958:Estradiol; D010959:Tissue Plasminogen Activator