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A comparative study of the effect of continuous combined conjugated equine estrogen plus medroxyprogesterone acetate and tibolone on blood coagulability.
Hum Reprod. 2007 Apr; 22(4):1186-91.HR

Abstract

BACKGROUND

Hormone therapy (HT) after the menopause is associated with increased risk of venous thromboembolism (VTE). Tibolone has pharmacodynamic properties different from other hormone preparations. We compared the effect of a combined HT and tibolone on the inhibition of haemostasis.

METHODS

Thirty-eight post-menopausal women were randomly assigned to 1.25 or 2.5 mg per day of tibolone or oral continuous combined conjugated equine estrogen plus medroxyprogesterone acetate (CEE/MPA). Inhibitors of haemostasis were measured at baseline and after 12 months.

RESULTS

Results from the two groups of women receiving tibolone were not significantly different and, to improve the power of the study, the two groups were merged. Higher concentration of protein S (1.16 versus 1.00 IU ml(-1); P = 0.005) and higher activated protein C resistance ratio (APC-R) (4.2 versus 3.65; P = 0.04) were observed in the tibolone group than in the CEE/MPA group. Both doses of tibolone increased APC-R significantly (P < 0.01). Tissue factor pathway inhibitor (TFPI) was lower in the CEE/MPA group than in the tibolone group (67.8 versus 79.9 ng ml(-1); P = 0.03). CEE/MPA reduced the concentration of antithrombin (P = 0.002), protein S (P < 0.001) and TFPI (P < 0.001). Both preparations reduced the concentration of plasminogen activator inhibitor 1 (P < 0.05).

CONCLUSIONS

Tibolone induces fewer pharmacological alterations on blood coagulability than CEE/MPA and has a potentially favourable effect on APC-R. This may translate into a corresponding low risk of VTE, as also indicated from the existing clinical data.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Frederiksberg Hospital, University of Copenhagen, Denmark.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17204528

Citation

Skouby, Sven O., et al. "A Comparative Study of the Effect of Continuous Combined Conjugated Equine Estrogen Plus Medroxyprogesterone Acetate and Tibolone On Blood Coagulability." Human Reproduction (Oxford, England), vol. 22, no. 4, 2007, pp. 1186-91.
Skouby SO, Sidelmann JJ, Nilas L, et al. A comparative study of the effect of continuous combined conjugated equine estrogen plus medroxyprogesterone acetate and tibolone on blood coagulability. Hum Reprod. 2007;22(4):1186-91.
Skouby, S. O., Sidelmann, J. J., Nilas, L., & Jespersen, J. (2007). A comparative study of the effect of continuous combined conjugated equine estrogen plus medroxyprogesterone acetate and tibolone on blood coagulability. Human Reproduction (Oxford, England), 22(4), 1186-91.
Skouby SO, et al. A Comparative Study of the Effect of Continuous Combined Conjugated Equine Estrogen Plus Medroxyprogesterone Acetate and Tibolone On Blood Coagulability. Hum Reprod. 2007;22(4):1186-91. PubMed PMID: 17204528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative study of the effect of continuous combined conjugated equine estrogen plus medroxyprogesterone acetate and tibolone on blood coagulability. AU - Skouby,Sven O, AU - Sidelmann,Johannes J, AU - Nilas,Lisbeth, AU - Jespersen,Jørgen, Y1 - 2007/01/04/ PY - 2007/1/6/pubmed PY - 2007/7/4/medline PY - 2007/1/6/entrez SP - 1186 EP - 91 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 22 IS - 4 N2 - BACKGROUND: Hormone therapy (HT) after the menopause is associated with increased risk of venous thromboembolism (VTE). Tibolone has pharmacodynamic properties different from other hormone preparations. We compared the effect of a combined HT and tibolone on the inhibition of haemostasis. METHODS: Thirty-eight post-menopausal women were randomly assigned to 1.25 or 2.5 mg per day of tibolone or oral continuous combined conjugated equine estrogen plus medroxyprogesterone acetate (CEE/MPA). Inhibitors of haemostasis were measured at baseline and after 12 months. RESULTS: Results from the two groups of women receiving tibolone were not significantly different and, to improve the power of the study, the two groups were merged. Higher concentration of protein S (1.16 versus 1.00 IU ml(-1); P = 0.005) and higher activated protein C resistance ratio (APC-R) (4.2 versus 3.65; P = 0.04) were observed in the tibolone group than in the CEE/MPA group. Both doses of tibolone increased APC-R significantly (P < 0.01). Tissue factor pathway inhibitor (TFPI) was lower in the CEE/MPA group than in the tibolone group (67.8 versus 79.9 ng ml(-1); P = 0.03). CEE/MPA reduced the concentration of antithrombin (P = 0.002), protein S (P < 0.001) and TFPI (P < 0.001). Both preparations reduced the concentration of plasminogen activator inhibitor 1 (P < 0.05). CONCLUSIONS: Tibolone induces fewer pharmacological alterations on blood coagulability than CEE/MPA and has a potentially favourable effect on APC-R. This may translate into a corresponding low risk of VTE, as also indicated from the existing clinical data. SN - 0268-1161 UR - https://www.unboundmedicine.com/medline/citation/17204528/A_comparative_study_of_the_effect_of_continuous_combined_conjugated_equine_estrogen_plus_medroxyprogesterone_acetate_and_tibolone_on_blood_coagulability_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/del498 DB - PRIME DP - Unbound Medicine ER -