Prediction of Changes in Levels of Haemostatic Variables during Natural Menstrual Cycle and Ovarian Hyperstimulation

Summary

To find if there is a relation between levels of haemostatic variables at low and high hormonal levels (oestradiol and progesterone) in an individual, blood samples were drawn from 12 women repeatedly during one menstrual cycle (Study I) and from 14 women undergoing in vitro fertilization, before hormonal stimulation and daily during the periovu- latory period (Study II). Regression coefficients were calculated between minimum (independent) and maximum (dependent) values in both studies. In Study II highly significant regression coefficients were found between oestradiol minimum (pretreatment) and maximum (mcdian 105 and 4730 pmol/1, respectively) for coagulation factors FVIII, von Willebrand Factor (antigen), FVII (activity and antigen), fibrinogen, protein C, protein S (free), antithrombin, plasminogen and plasminogen activator inhibitor-1; furthermore, between progesterone-minimum at day -3 or -2 (related to ovum pick up) and maximum (median 4.7 and 98 nmol/1, respectively) for FVIII, von Willebrand Factor, FVII (activity and antigen), protein C, protein S (free), and plasminogen. In Study I, where much lower hormonal levels were obtained at maximum (oestradiol median 297 pmol/1 and and progesterone 47 nmol/1), the same pattern was observed especially for FVIII, FX, fibrinogen, plasminogen and plasmin inhibitor. Thus, the concentration of a haemostatic variable at a low oestradiol or progesterone level can predict the level at a high hormonal level.

• References

• 1 Blombäck M, Hall K, Ritzén M. Estrogen treatment of tall girls: risk of thrombosis?. Pediatrics 1983; 72: 416-419
• 2 Blombäck M, Eneroth P, Landgren BM, Lagerstrӧm M, Andersson O. On the intraindividual and gender variability of haemostatic components. Thromb Haemost 1992; 67: 70-75
• 3 Bremme K, Wramsby H, Andersson O, Wallin M, Blombäck M. Do lowered factor VII levels at extremely high endogenous oestradiol levels protect against thrombin formation?. Blood Coagulation and Fibrinolysis 1994; 5: 205-210
• 4 Bonnar J. Coagulation effects of oral contraception. Am J Obstetr Gynecol 1987; 157: 1042-1048
• 5 Blombäck M. Changes in blood coagulation and fibrinolysis during pregnancy and the menstrual cycle, new methods for detecting the changes. Oral contraceptives and cardiovascular disease. Advances in Contraception. Zatuchni GI, Elstein M. eds. Kluwer Academic Publishers; London: 1991. 7. suppl 3: pp 259-272
• 6 Scarabin PY, Plu-Bureau G, Bara L, Bonithon-Kopp C, Guize L, Samama MM. Haemostatic variables and menopausal status: influence of hormone replacement therapy. Thromb Haemost 1993; 70: 584-587
• 7 Robinson GE. Low dose combined oral contraceptives Brit J Obstetr Gynaecol. 1994; 101: 1036-1041
• 8 Stampfer MJ, Colditz GA, Willett C, Manson JE, Rosner B, Speizer FE, Hennekens CH. Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the Nurses’ Health Study. New Engl J Medicine 1991; 325: 756-762
• 9 Hamsten A, Blombäck M, Wiman B, Svensson J, Szamosi A, de FaireU, Mettinger M. Haemostatic function in myocardial infarction. Br Heart J 1986; 55: 58-66