1. Coagulation Factors, Postmenopausal Hormone Replacement Therapy and the Risk of Venous Thrombosis: The WHI Clinical Trials of Postmenopausal Hormone Therapy
- Author
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Mary Cushman, J. David Curb, Charles B. Eaton, Barbara V. Howard, Joseph C. Larson, Randall S. Stafford, Susan R. Heckbert, Lawrence S. Phillips, Jennifer Hays-Grudo, Frits R. Rosendaal, and Alison E. Baird
- Subjects
Gynecology ,medicine.medical_specialty ,biology ,business.industry ,Women's Health Initiative ,medicine.medical_treatment ,Immunology ,Hormone replacement therapy (menopause) ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Protein S ,Internal medicine ,Relative risk ,Nested case-control study ,medicine ,Factor V Leiden ,biology.protein ,Medroxyprogesterone acetate ,Hormone therapy ,business ,medicine.drug - Abstract
Background. Postmenopausal estrogen (E) therapy, especially in combination with progestin (P) doubles the relative risk of venous thrombosis (VTE). Risk with hormones is higher with increasing age, obesity and with factor V Leiden. We studied coagulation markers as susceptibility factors for postmenopausal hormone-related VTE. Methods. The Women’s Health Initiative program included two placebo-controlled double-blind randomized trials of two E regimens, E (conjugated equine estrogens) or E+P (E + medroxyprogesterone acetate), in 16,608 postmenopausal women aged 50–79. We performed a nested case control study that measured baseline levels of coagulation markers in 215 women who developed VTE during follow up and 867 age-matched controls. The joint effects of treatment assignment to either E regimen vs placebo and prespecified abnormal levels of each coagulation factor on relative risk of VTE were estimated by logistic regression adjusting for age, race, body-mass index and type of E regimen. Results. Low levels of protein C and free protein S ( Conclusions. We report new findings of elevated F1-2 and PAP as VTE risk factors in women in this prospective study nested in trials of E or E+P versus placebo. Protein C or S values below the 5th percentile were also clinically relevant even though they do not represent inherited deficiency. Lower protein C and free protein S, and higher D-dimer, F1-2 and PAP all identified women at increased risk of VTE with hormones. If our findings are confirmed in management studies, measurement of these factors might assist women with decision-making on safety of E or E+P.
- Published
- 2007
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