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Effects of tibolone and continuous combined hormone replacement therapy on parameters in the clotting cascade: a
U H Winkler1, R Altkemper, B Kwee
1Hemostasis Unit, University Hospital of Essen, Germany. ulrich-horst.winkler@fek.de
Objective:
To determine the effects of tibolone and continuous combined HRT (ccHRT) on parameters in the clotting cascade.
Design:
Randomized, double-blind study.
Setting:
Hemostasis unit of a university hospital clinic in Germany.
Patient(S):
Sixty healthy postmenopausal women.
Intervention(S):
Twenty-nine subjects were treated with tibolone (2.5 mg/d) and 31 with oral ccHRT containing estradiol (2 mg/d) + estriol (1 mg/d) + norethindrone acetate (1 mg/d).
Main Outcome Measure(S):
Effects on parameters in the clotting cascade at baseline and after 12 and 24 weeks of treatment.
Result(S):
Tibolone increased fibrinolysis parameters without significantly altering coagulation parameters. Treatment with ccHRT resulted in a stimulating effect on parameters of both fibrinolysis and coagulation. Tibolone showed a stronger reduction of factor VII activity; less reduction of AT-III, protein C activity, and protein S activity; stronger increase of the activated partial thromboplastin time, plasminogen and plasminogen-antiplasminogen complexes; and less increase of D-Dimer than ccHRT. Both preparations similarly reduced climacteric complaints, whereas tibolone showed less breast complaints than ccHRT.
Conclusion(S):
This study confirms that tibolone, and to a lesser extent also ccHRT, changes hemostasis parameters toward a more fibrinolytic profile, which may diminish the risk of venous thrombosis.