Hormone replacement therapy and hypercoagulability. Results from the Prospective Collaborative Danish Climacteric...

Area of Science:

• Endocrinology
• Hematology
• Pharmacology

Background:

• Hormone replacement therapy (HRT) is widely used for menopausal symptom management.
• The impact of different HRT regimens on hemostatic balance requires thorough investigation.
• Understanding these effects is crucial for assessing thrombotic risk associated with HRT.

Purpose of the Study:

• To evaluate how various HRT regimens influence hemostatic balance.
• To assess changes in fibrin turnover markers and coagulation inhibitors.
• To determine the relationship between HRT composition and hemostatic alterations.

Main Methods:

• An open-label, randomized study involving 149 postmenopausal women.
• Six groups were compared: one control and five HRT treatment groups.
• Measurements included prothrombin fragment 1+2, fibrin degradation products, and coagulation inhibitors (antithrombin, protein C, protein S, activated protein C ratio) over 12 months.

Main Results:

• All HRT groups showed decreased antithrombin and protein S levels.
• Protein C and activated protein C ratio decreased in most HRT groups.
• Fibrin degradation products increased, and prothrombin fragment 1+2 increased significantly in one specific HRT group (Group F).

Conclusions:

• HRT significantly diminishes the blood's coagulation inhibitory potential.
• The observed procoagulant effect is dependent on the specific estrogen/progestin combination used in HRT.
• These findings suggest that HRT-induced procoagulant activity could contribute to clinical thrombosis in predisposed individuals.