Search

Introduction We have recently reported that different hormone regimens given to healthy post-menopausal women had markedly different effects on activation of coagulation. Low-dose hormone therapy (HT) and raloxifene, as opposed to conventional-dose HT and tibolone, were associated with no or minor activation of coagulation. The aim of this study was to elucidate the mechanism(s) for differences in coagulation activation by analysing clotting and fibrinolytic factors and coagulation inhibitors. Materials and methods 202 healthy women were randomly assigned to receive treatment for 12 weeks with either low dose HT containing 1 mg 17 β-estradiol + 0.5 mg norethisterone acetate (NETA) ( n = 50), conventional dose HT containing 2 mg 17 β-estradiol and 1 mg NETA ( n = 50), 2.5 mg tibolone ( n = 51), or 60 mg raloxifene ( n = 51) in an open-label design. Results The conventional-and low-dose HT groups generally showed similar effects, i.e., reductions in both clotting factors and inhibitors, but the effects were markedly more pronounced in the conventional-dose HT group. Compared with the low-dose HT group those treated with tibolone showed more pronounced decreases in factor VII, less reduction of antithrombin and protein C and even increased levels in protein S and tissue factor pathway inhibitor. As opposed to the low-dose HT group the reductions in inhibitors in the raloxifene group were smaller. Moreover in those allocated to raloxifene reduced levels of fibrinogen were seen. Conclusions Our study demonstrates that the different HT regimens and raloxifene exert differential effects on coagulation factors, inhibitors and fibrinolytic factors.

The long-term mortality and incidence of cancer after pregnancy-related venous thrombosis (VT) is not known. In this population-based cohort study we identified women with a first-ever pregnancy-related VT (cases, n = 557)) from 18 Norwegian hospitals during 1990-2003. Hospital controls (n = 1214) were selected among women who gave birth at the same time as a case. All participants were linked to the Norwegian Cause of Death Registry and to the Cancer Registry of Norway in 2012. The general age-adjusted Norwegian female population was used as a second control group to calculate the standardized mortality ratio (SMR) and the standardized incidence ratio (SIR) for cancer. Ten cases (1.8%) and seven hospital controls (0.6%) died during follow-up. Mortality was 3.2 times higher among cases as compared with hospital controls when adjusted for age (HR 3.2, 95% confidence interval 1.2-8.5, p = 0.018). The SMR for the first year of follow-up was 18.8 (7.8-45.3) and for the rest of the study period 0.9 (0.4-2.0). Fifteen cases (2.7%) and 13 hospital controls (1.1%) were diagnosed with cancer after index pregnancy. The incidence of cancer was 2.6 times higher among cases compared with hospital controls when adjusted for age (HR 2.6, 1.3-5.6, p = 0.011), but compared with the age-adjusted female population in Norway there was no excess risk of cancer (SIR 1.0, 95% CI 0.6-1.7). Mortality and incidence of cancer after pregnancy-related VT was low. Both were increased among cases compared with hospital controls, but not when compared with the general population, except for mortality during the first year after VT.

Ferrans and Powers QOL Index (QLI) and the General Health Questionnaire (GHQ-20) as measures of generic QOL and well-being. Self-reported Villalta score for diagnosing post-thrombotic syndrome was also included in the questionnaire. After exclusion of 2 patients with unknown location for VT, the study population comprised 311 patients and 353 controls. Results: Of the cases, 214 had DVT in lower limbs, 74 had PE and 23 had DVT located outside lower limbs/lungs. QOL assessed by QLI did not differ between cases and controls (mean score 23.1 versus 23.7), neither did well-being assessed by GHQ-20 (mean score 18.7 versus 17.8). Nevertheless, cases reported pain outside lower limbs and muscle-skeletal problems more often and were more often physically worn out after work compared to controls. Cases who developed PTS reported poorer health, had more often pain-, skin-, and psychiatric problems, used more frequently analgesic drugs, and were more often on sick-leave as compared to those without PTS. Comment: The long-term outcomes regarding generic QOL and wellbeing three to 16 years after pregnancy-related VT were comparable to the reference population in the present study, but cases reported more pain andmuscle-skeletal problems and reduced physical tolerance for a day's work. Cases with PTS as a chronic complication to DVT in a lower limb seem to have particularly reduced outcome.