The effects of long-term hormone-replacement therapy on coagulation, fibrinolysis and inhibitors in postmenopausal women

Objective: To study the long-term effects of hormone-replacement therapy (HRT). Methods: Twenty-one menopausal Chinese women who were currently on HRT were studied for the long-term effects of HRT on hemostasis. Another 21 age-matched healthy women not on HRT served as controls. Results: Enhanced thrombin generation was seen in women on long-term HRT. Antithrombin III (ATIII) antigen was significantly reduced but not its activity level and so was FVII. Elevated t-PA activity and u-PA antigen were seen with reduced t-PA antigen. Plasminogen activator inhibitor-1 (PAI-1) levels were significantly reduced together with D-dimer in HRT. Conclusions: Long-term HRT was associated with enhanced thrombin generation and countered by enhanced systemic t-PA activity suggesting an equilibrium state. There was no enhanced cardiovascular risk in long-term HRT as indicated by the observed reduction in t-PA antigen, PAI-I and FVII levels. However, a larger prospective study is required to confirm these findings. (C) 1998 International Federation of Gynecology and Obstetrics.