For non-oral HT , decreases in lipoprotein(a ) , cell adhesion molecules , and factor VII generally were significant , resistance to activated protein C ( APCr ) was slightly increased , and other markers including CRP and homocysteine did not change .
Compared with oral HT , changes in CRP and APCr were smaller , changes in cell adhesion molecules and some fibrinolytic parameters tended to be smaller , whereas changes in other factors including lipoprotein(a ) and homocysteine did not differ .
( S ) Potentially unfavorable changes seen with oral HT on two important markers , CRP and APCr , are substantially smaller with non-oral HT .
Non-oral HT has minor effects on the other cardiovascular risk markers studied .
Therefore , compared with oral HT , non-oral HT appears be safer with respect to atherosclerotic and venous thromboembolic disease risk
OBJECTIVE To review the effects of non-oral administration of postmenopausal hormone therapy ( HT ) on risk markers for atherosclerotic and venous thromboembolic disease .
Non-oral postmenopausal HT appears not to increase venous thromboembolic risk , whereas the effect on coronary heart disease risk is less clear .
Effect of Oral and Transdermal Estrogen Replacement Therapy on Hemostatic Variables Associated With Venous Thrombosis: A Randomized, Placebo-Controlled Study in Postmenopausal Women
Objective —The purpose of this study was to investigate whether the effect of transdermal estrogen therapy in postmenopausal women differs from that of oral therapy with regard to resistance to activated protein C ( APC ) , an important risk factor for venous thrombosis , and levels of related proteins , such as protein S , protein C , and prothrombin . Methods and Results —In a r and omized , double-blind , placebo-controlled study , 152 healthy hysterectomized postmenopausal women received daily either placebo ( n=49 ) , transdermal 17&bgr;-estradiol ( E2 ) 50 & mgr;g ( tE2 group , n=33 ) , oral E2 1 mg ( oE2 group , n=37 ) , or oral E2 1 mg combined with gestodene 25 & mgr;g ( oE2+G group , n=33 ) for 13 28-day treatment cycles , followed by 4 cycles of placebo for each group . Plasma sample s were collected at baseline and in cycles 4 , 13 , and 17 . In cycle 13 , significant increases versus baseline and placebo were found in normalized APC sensitivity ratios ( nAPCsr ) in all treated groups ( tE2 , + 26.9 % ; oE2 , + 102.7 % ; oE2+G , + 69.9 % ) . Increases in nAPCsr were significantly higher in the oral treatment groups than in the tE2 group . In addition , compared with baseline and placebo , after 13 cycles , decreases were observed in total protein S ( tE2 , −4.1 % ; oE2 , −7.9 % ; oE2+G , −5.8 % ) , free protein S ( tE2 , −7.1 % ; oE2 , −8.4 % ; oE2+G , −5.2 % ) , and protein C in the oE2+G group ( −6.4 % ) , but these changes did not explain the increase in nAPCsr . Changes in prothrombin were small and also did not affect the nAPCsr . Conclusions —Increases were observed in resistance to APC , which were more pronounced in the oral treatment groups than in the transdermal group . The increase in resistance to APC was not explained by changes in protein S , protein C , or prothrombin and may contribute to the increased incidence of venous thrombosis in users of hormone replacement therapy
For non-oral HT , decreases in lipoprotein(a ) , cell adhesion molecules , and factor VII generally were significant , resistance to activated protein C ( APCr ) was slightly increased , and other markers including CRP and homocysteine did not change .
Compared with oral HT , changes in CRP and APCr were smaller , changes in cell adhesion molecules and some fibrinolytic parameters tended to be smaller , whereas changes in other factors including lipoprotein(a ) and homocysteine did not differ .
( S ) Potentially unfavorable changes seen with oral HT on two important markers , CRP and APCr , are substantially smaller with non-oral HT .
Non-oral HT has minor effects on the other cardiovascular risk markers studied .
Therefore , compared with oral HT , non-oral HT appears be safer with respect to atherosclerotic and venous thromboembolic disease risk
OBJECTIVE To review the effects of non-oral administration of postmenopausal hormone therapy ( HT ) on risk markers for atherosclerotic and venous thromboembolic disease .
Non-oral postmenopausal HT appears not to increase venous thromboembolic risk , whereas the effect on coronary heart disease risk is less clear .