The effects of hormone replacement therapy on hemostatic variables in women with angiographically verified coronary artery disease: Results from the estrogen in women with atherosclerosis study

Data on the effect of hormone replacement therapy on hemostasis are inconsi stent, and there are few data in women with coronary artery disease. In a s ingle-center, open, randomized study, 118 postmenopausal women with angiogr aphically verified coronary artery disease were randomized to hormone repla cement therapy, given as long-cycle transdermal 17-beta-estradiol (50 mu g/ 24 hour) for 3 months with sequential medroxy-progesterone acetate for 14 d ays, or to a control group receiving no therapy. Hemostatic parameters were measured at baseline and after 3 and 12 months of therapy. The coagulation inhibitors antithrombin, protein C, and protein S, but not tissue factor p athway inhibitor, decreased significantly from baseline in the hormone repl acement therapy group at both 3 and 12 months as compared with the control group. The absolute decreases within the hormone replacement therapy group were 3 to 10%, No significant differences between the two treatment groups were observed for the coagulation products prothrombin fragment 1+2 or thro mbin-antithrombin complex or for D-dimer, although there were significant d ecreases in the levels within the hormone replacement therapy group. Levels of fibrinogen, activated factor VII, and factor VII antigen were not signi ficantly influenced by hormone replacement therapy treatment. Similarly, no nsignificant changes were detected for the fibrinolytic parameters tissue p lasminogen activator activity, tissue plasminogen activator antigen, and gl obal fibrinolytic activity, but plasminogen activator inhibitor type 1 was significantly lower in the hormone replacement therapy group due to a quest ionable increase in the levels in the control group. In conclusion, treatme nt with transdermal estradiol combined with long-cycle progestins was assoc iated with no net activation of coagulation despite reduced levels of coagu lation inhibitors. (C) 2000 Elsevier Science Ltd. All rights reserved.