The Adverse Effects of Estrogen and Selective Estrogen Receptor Modulators on Hemostasis and Thrombosis

被引:31
作者
Artero, Arturo [2 ]
Tarin, Juan J. [4 ]
Cano, Antonio [1 ,3 ]
机构
[1] Univ Valencia, Fac Med, Dept Pediat Obstet & Gynecol, Valencia, Spain
[2] Univ Hosp Dr Peset, Serv Internal Med, Valencia, Spain
[3] Univ Hosp Dr Peset, Serv Obstet & Gynecol, Valencia, Spain
[4] Univ Valencia, Fac Biol Sci, Dept Funct Biol & Phys Anthropol, Valencia, Spain
关键词
contraceptive; estrogen; hormone therapy; SERM; thrombosis; HORMONE REPLACEMENT THERAPY; IDIOPATHIC VENOUS THROMBOEMBOLISM; CONJUGATED EQUINE ESTROGENS; CONTRACEPTIVE VAGINAL RING; DOSE ORAL-CONTRACEPTIVES; VERTEBRAL FRACTURE RISK; HUMAN-ENDOTHELIAL-CELLS; ACTIVATED PROTEIN-C; POSTMENOPAUSAL WOMEN; BREAST-CANCER;
D O I
10.1055/s-0032-1328883
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Agonists of the estrogen receptor include estrogens and selective estrogen receptor modulators (SERMs). Both types of compounds increase the risk for thrombosis in the arterial and the venous tree. The magnitude of the effect is influenced by potency, which depends on the type of compound and the dose. The particulars of the process change in each territory. Atherosclerosis, which creates local inflammatory conditions, may favor thrombogenesis in arteries. A direct effect of estrogen agonists is also well endorsed at both arteries, as suggested from data with high-estrogenic contraceptives, and veins. Dose reduction has been proved to be an effective strategy, but there is debate on whether additional benefit may be attained beyond a certain threshold. Hormone therapy and SERMs exhibit a lower potency estrogenic profile, but are mainly used by older women, who have a baseline increased thrombogenic risk. When used as sole agents, estrogens substantially reduce the increased risk (venous thrombosis) or may even be neutral (coronary disease). SERMs exhibit a neutral profile for coronary disease and possibly for stroke but not for venous thrombosis.
引用
收藏
页码:797 / 807
页数:11
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