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(Stroke. 2007;38:e11.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Inoue et al

Cheryl D. Bushnell, MD, MHS

Duke Center for Cerebrovascular Disease, Duke University Medical Center, Durham, NC

Gregory J. Del Zoppo, MD

Center for Experimental and Molecular Medicine, The Scripps Research Institute, San Diego, Calif

Response:

Thank you for your interesting comment and for sharing your experiences regarding hormone replacement therapy (HRT) effects on protein C and S levels in women with stroke. Although case reports from your practice and other larger studies cited in our article¹ support the notion that protein C and S levels may be lowered in women using HRT at the time of stroke, this conclusion is somewhat confounded by the timing of the blood draws for these coagulation proteins. Both proteins C and S are lowered in the acute phase of thrombosis,^2,3 inflammation or in an acute illness requiring hospitalization.⁴ Therefore, was the apparent deficiency of protein C and S from the acute phase of the stroke or from the HRT? As we discussed in the Advancing the Study of Women Conference proceedings,¹ HRT may have a mild to moderate prothrombotic effect on hemostasis, but whether this is the cause of ischemic stroke in the majority of women remains uncertain.

Acknowledgments

Disclosures

None.

References

1. Bushnell CD, Hurn PD, Colton C, Miller VM, del Zoppo G, Elkind M, Stern BJ, Herrington D, Ford Lynch G, Gorelick P, James A, Brown C, Choi E, Bray PF, 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. Miletich JP. Laboratory diagnosis of protein C deficiency. Seminars in Thrombosis and Hemostasis. 1990; 16: 169–176.[Medline] [Order article via Infotrieve]
3. Comp PC. Laboratory evaluation of protein S status. Seminars in Thrombosis and Hemostasis. 1990; 16: 177–181.[Medline] [Order article via Infotrieve]
4. Mayer SA, Sacco RL, Hurlet-Jensen A, Shi T, Mohr JP. Free protein S deficiency in acute ischemic stroke: a case-control study. Stroke. 1993; 24: 224–227.[Abstract/Free Full Text]

This Article Full Text (PDF) All Versions of this Article: 38/5/e11    most recent STROKEAHA.106.479865v1 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 Bushnell, C. D. Articles by Del Zoppo, G. J. Search for Related Content PubMed PubMed Citation Articles by Bushnell, C. D. Articles by Del Zoppo, G. J.