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(Stroke. 2007;38:e10.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Stroke in Women During Long-Term Hormone Replacement Therapy Influencing Coagulation Systems

Nobuhiro Inoue, MD, PhD

Department of Neurosurgery, Kumamoto Neurosurgical Hospital, Kumamoto, Japan

Akihito Hashiguchi, MD, PhD Homare Ichimura, MD

Division of Neurosurgery, Shinbeppu Hospital, Oito, Japan

Susumu Yoshioka, MD

Department of Neurosurgery, Oita Prefectural Hospital, Oita, Japan

Satoshi Goto, MD, PhD

Department of Clinical Neuroscience, Institute of Health Biosciences, Tokushima University Graduate School of Medical Sciences, Tokushima, Japan

Yukitaka Ushio, MD, PhD

Director, Otemae Hospital, Osaka, Japan

To the Editor:

We read with great interest the review of Bushnell et al.¹ Since 2001 we encountered 4 women who experienced cerebral infarction during long-term hormone replacement therapy (HRT).^2,3 We pointed out in our articles that their cerebral infarcts were attributable to HRT-mediated changes in the coagulation system. The review of Bushnell et al¹ described that the precise mechanism of an estrogen-associated increase in risk for venous (as well as arterial) thrombotic events remains unknown despite accumulated evidences of hemostatic biomarkers change in a prothromboic direction. In our patients we observed depressed levels of protein C and S activity. Protein S activity returned to the normal range after cessation of HRT.³ The HRT-induced procoagulant state might be attributable to an interaction among subtle changes in the coagulation system. Based on our published findings, we strongly suggest that the level of protein C and S activity be monitored in women on long-term HRT to prevent the occurrence of stroke.

Acknowledgments

Disclosures

None.

References

1. Bushnell CD, Hurn P, Colton C, Miller VM, Zoppo G, Elkind MSV, Stern B, Herrington D, Ford-Lynch G, Gorelick P, James A, Brown CM, Choi E, Bray P, Newby LK, Goldstein LB, Simpkins J. Advancing the study of stroke in women: summary and recommendations for future research from an NINDS-sponsored multidisciplinary working group. Stroke. 2006; 37: 2387–2399.[Abstract/Free Full Text]
2. Inoue N, Kihara K, Hashiguchi A, Maehara F, Yoshioka S, Ushio Y. Cerebral embolism and hormone replacement therapy. J Clin Pharm Therapeutics. 2001; 26: 181–186.[CrossRef]
3. Inoue N, Ichimura H, Goto S, Ushio Y. Cerebral thrombosis in a postmenopausal woman on HRT. J Clin Neurosci. 2005; 12: 109–110.[Medline] [Order article via Infotrieve]

This Article Full Text (PDF) Correction (v38,pe36) All Versions of this Article: 38/5/e10    most recent STROKEAHA.106.474635v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Inoue, N. Articles by Ushio, Y. Search for Related Content PubMed PubMed Citation Articles by Inoue, N. Articles by Ushio, Y. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Hormone Replacement Therapy Stroke