Roger Peverill, MB, BS, PhD
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Peverill R. Hormone Therapy and Risk for Venous Thromboembolism: Comments and Correction. Ann Intern Med. 2001;134:80. doi: 10.7326/0003-4819-134-1-200101020-00019
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Published: Ann Intern Med. 2001;134(1):80.
TO THE EDITOR:
Grady and colleagues (1) speculate that effects of oral estrogen on factor VII and protein C may be possible mechanisms for the prothrombotic effects of hormone replacement therapy (HRT) observed in the Heart and Estrogen/progestin Replacement Study (HERS). I am concerned that the specific points made by the authors about protein C and factor VII provide an oversimplistic and somewhat inaccurate interpretation of the available data.
First, Grady and colleagues postulated that the higher levels of protein C seen with the use of estrogen may be thrombogenic. However, protein C is a natural anticoagulant; it is actually reductions in protein C levels that are associated with an increased risk for thrombosis. Furthermore, the effects of combined HRT with estrogen and progestin on coagulation factors are most relevant to HERS. Of note, in the same study that found higher levels of protein C with the use of estrogen, no effect on protein C levels was evident in current users of estrogen and progestin (2).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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