title: Effect of two oral doses of 17beta-estradiol associated with dydrogesterone on thrombin generation in healthy menopausal women: a randomized double-blind placebo-controlled study.
abstract: Oral hormone therapy is associated with an increased risk of venous thrombosis. Drug agencies recommend the use of the lowest efficient dose to treat menopausal symptoms for a better risk/ratio profile, although this profile has not been totally investigated yet. The aim of the study was to compare the effect of the standard dose of 17beta-estradiol to a lower one on thrombin generation (TG). In a 2-month study, healthy menopausal women were randomized to receive daily 1mg or 2 mg of 17beta-estradiol (E1, n = 24 and E2, n = 26; respectively) with 10 mg dydrogesterone or placebo (PL, n = 22). Plasma levels factors VII, X, VIII and II were assessed before and after treatment as well as Tissue factor triggered TG, which allows the investigation of the different phases of coagulation process. The peak of thrombin was higher in hormone therapy groups (E1: 42.39 +/- 50.23 nm, E2: 31.08 +/- 85.86 nm vs. 10.52 +/- 40.63 nm in PL, P = 0.002 and P = 0.01). Time to reach the peak was also shortened (PL: 0.26 +/- 0.69 min vs. E1: -0.26 +/- 0.80 min, E2: -0.55 +/- 0.79 min, P <10(-3) for both comparisons) and mean rate index of the propagation phase of TG was significantly increased. Among the studied clotting factors, only the levels of FVII were significantly increased after treatment administration. The two doses of 17beta-estradiol induced in a similar degree an acceleration of the initiation and propagation phase of tissue factor triggered thrombin generation and a significant increase of FVII coagulant activity.
authors.affiliation: Department of Clinical Pharmacology, APHP, Saint-Antoine hospital, Paris University, France. alexandra00rousseau@gmail.com
authors.forename: Alexandra
authors.initials: A
authors.lastname: Rousseau
authors.forename: Annie
authors.initials: A
authors.lastname: Robert
authors.forename: Grigoris
authors.initials: G
authors.lastname: Gerotziafas
authors.forename: Dahlia
authors.initials: D
authors.lastname: Torchin
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Karine
authors.initials: K
authors.lastname: Lacut
authors.forename: Christian
authors.initials: C
authors.lastname: Libersa
authors.forename: Eric
authors.initials: E
authors.lastname: Dasque
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Démolis
authors.forename: Ismail
authors.initials: I
authors.lastname: Elalamy
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001779:Blood Coagulation Factors / Q000187:drug effects / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004394:Dydrogesterone / Q000008:administration & dosage / Q000494:pharmacology*; D004958:Estradiol / Q000008:administration & dosage / Q000494:pharmacology*; D004967:Estrogens / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D011372:Progestins / Q000008:administration & dosage / Q000494:pharmacology; D013917:Thrombin / Q000187:drug effects* / Q000378:metabolism; D013997:Time Factors
chemical_list: D001779:Blood Coagulation Factors; D004967:Estrogens; D011372:Progestins; D004958:Estradiol; D004394:Dydrogesterone; D013917:Thrombin