Platelet Aggregability And Fibrinolytic Activity In Different Phases Of Menstrual Cycle
Platelet Aggregability And Fibrinolytic Activity
Keywords:
Platelet aggregability, fibrinolytic activity, Phases of menstrual cycleAbstract
Background:- Sexual dimorphism in coronary artery disease (CAD) mortality is attributed to the cardioprotective effects of estrogen.This is reinforced by the observation that incidence of myocardial infarction is higher in menstrual phase, corresponding with low estrogen levels, in people who are predisposed to CAD due to the presence of modifiable risk factors. Cyclical variability of estrogen and progesterone in normal menstruating women may be associated with variability of platelet aggregation and fibrinolytic activity.There exists a delicate balance between fibrinolytic activity and platelet aggregation governing the haemostatic status. Objectives:- Platelet aggregability and fibrinolytic activity were measured and compared during menstrual (1-5 days), follicular ( 9-12 days) and luteal (20-25days) phases of menstrual cycle. Method:- In this cross sectional study of 50 normal menstruating females in age group of 18-35yrs, Platelet aggregability was measured by ADP induced platelet aggregation on a spectrophotometer. Fibrinolytic activity was estimated by euglobulin clot lysis time. Results :- Results were analyzed by students unpaired ‘t’ test. Change in platelet aggregability was found 0.12 ± 0.15, 0.04 ± 0.04 and 0.08 ± 0.07 in menstrual, follicular and luteal phase respectively. Platelet aggregability was found significantly (p < 0.001) higher in menstrual and luteal phases than follicular phase. The mean euglobulin clot lysis time was found 277.6 ± 43.96, 147.6 ± 52.78 and 244.6 ± 59.12 in menstrual, follicular and luteal phase respectively. Fibrinolytic activity was found significantly (p < 0.0001) lower in menstrual and luteal phases than follicular phase. Conclusion :- According to the present study, in both luteal and menstrual phases, not only platelet aggregability was found higher, but fibrinolytic activity was also found lower as compared to follicular phase, thereby pointing towards thrombotic tendency in these phases. Hence, these phases require careful monitoring in women who are susceptible to thrombotic disorders. However, follicular phase with lower platelet aggregability and higher fibrinolytic activity is relatively free from thrombotic risk.
References
2. Michael E. Mendelsohn, Richard H. Karas. The protective effects of estrogen on thecardiovascular system. N Engl J Med 1999Jun; 340;23: 1801-1810.
3. Hiroaki Kawano, Takeshi Motoyama, Masamichi Ohgushi, Kiyotaka Kugiyama, Hisao Ogawa, Hirofumi Yasue. Menstrual cyclic variation of myocardial ischaemia in premenopausal women with variant angina. Ann Intern Med 2001; 135: 977-981.
4. Herkert O, Kuhl H, Sandow J, Busse R, Schini- Kerth VB. Sex steroids used in hormonal treatment increase vascular procoagulant activity by inducing thrombin receptor(PAR-1) expression: role of the glucocorticoid receptor. Circulation 2001; 104(23):2816-31.
5. Feuring M, Christ M, Roell A, Schueller P, Losel R,Dempfle CE, Schultz A, Wehling M. Alterations in platelet function during the ovarian cycle. Blood Coagulation & Fibrinolysis 2002 Jul; 13; 5: 443-447.
6. Siegbahn A, Odlind V, Hedner U, Venge P. Coagulation and fibrinolysis during the normal menstrual cycle. Upsala Journal of Medical Sciences. 1989; 94(2):137-52.
7. Melamed N., Yogev Y., Buganim T., Altman E., Glezerman M. The effect of menstrual cycle on platelet aggregation in reproductive age women. Platelets. 2010; 21(5):343-7.
8. Elsa-Grace V. Giardina, Hong Jun Chen, Robert R. Sciacca, LeRoy E. Rabbani. Dynamic variability of haemostatic and fibrinolytic factors in young women. J Clin Endocrinol Metab 2004; 80: 6179-6184.
9. Guyton & Hall. Endocrinology and reproduction. Textbook of medical physiology; 11th edition: 974.
10. L. Poller, Celia M. Priest, Jean M. Thomson. Platelet aggregation and strenuous exercise. J. Physiology 1971; 213: 525-531.
11. T. k. Das, H. Jana. Basal oxygen consumption during different phases of menstrual cycle. Indian J Med Res (B) 1991 Feb; 94: 16-19.
12. O’Brien J.R. Some effects of adrenaline and anti-adrenaline compounds on platelets in-vitro and in-vivo. Nature. 1963;200: 763-764.
13. Monamy Buckell. The effect of citrate on euglobulin methods of estimating fibrinolytic activity. J Clin Path 1958; 11: 403.
14. Hoffbrand William. The vascular functions of platelets. Eleventh edition. Postgraduate Haematology. McGraw Hill.2005: 808-824.
15. Teran E., Escudero C, Vivero S. Physiological changes in platelet aggregation and nitric oxide levels during menstrual cycle in healthy women. Nitric oxide 2002 Nov; 7;3: 217-220.
16. Moncada S, Higgs A. The L-arginine-nitric oxide pathway. N Engl J Med. 1993;329:2002-12.
17. Fogelberg M, Vesterqvist O, Diczfalusy U, Henriksson P. Experimental atherosclerosis: effects of oestrogen and atherosclerosis on thromboxane and prostacyclin formation. Eur J Clin Invest. 1990 Feb; 20(1):105-10.
18. Jilma B, Hildebrandt J, Kapiotis S, Wagner OF, Kitzweger E, Müllner C, Monitzer B, Krejcy K, Eichler HG. Effects of estradiol on circulating P-selectin. J Clin Endocrinol Metab. 1996 Jun; 81 (6): 2350-5.
19. Serdar E Bulus, Eli Y Adashi.The Physiology and pathology of the female reproductive system. Reproduction.William’s textbook of endocrinology 11th edition.2009; Section 5: chapter 16:564-565.
20. Motomiya T, Yamazaki H. Plasma β-thromboglobulin and platelet factor 4 during the normal menstrual cycle. Acta Haematologica, International journal of haematology Japan (JPN).1981; 44:193-195.
21. Medina R. A., Aranda E., Verdugo C., Kato S. Owem G. The action of ovarian hormones in cardiovascular disease. Biological Research 2003; 36:325-341.
22. MaryFran R. Sowers, Karen A. Mathews, Mary Jannausch, John F. Randolph, Daniel McConnell, Kim Sutton-Tyrell, Roderick Little, Bill Lasley, Richard Pasternak. Haemostatic factors and estrogen during the menopausal transition. Journal of Clinical Endocrinology & Metabolism. 2005;90: 5942-5948.
23. Pierre-Yves Scarabin; Martine Alhenc-Gelas; Genevieve Plu-Bureau; Pascal Taisne; Rachid Agher; Martin Aiach. Effects of oral and transdermal estrogen/progesterone regimens on blood coagulation and fibrinolysis in postmenopausal women. Arteriosclerosis Thrombosis & Vascular Biology 1997; 17: 3071-3078.24. Notelovitz M, Kitchens CS, Rappaport V, Coone L, Dougherty M. Menopausal status associated with increased inhibition of blood coagulation. Am J Obstet Gynecol. 1981 Sep 15;141(2):149-52.
25. Stampfer MJ, Colditz GA, Willett WC, Manson JE, Rosner B, Speizer FE, Hennekens CH. Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the nurse’s health study. N Engl J Med. 1991 Sep 12; 325(11):756-62.
26. Koh SC, Prasad RN, Fong YF. Hemostatic status and fibrinolytic response potential at different phases of the menstrual cycle. Clinical & Applied Thrombosis/ Hemostasis. 2005 Jul; 11(3):295-301.
27. Wallmo L, Gyzander E, Karlsson K, Lindstedt G, RÃ¥dberg T, Teger-Nilsson AC. Alpha 2-antiplasmin and alpha 2-macroglobulin--the main inhibitors of fibrinolysis--during the menstrual cycle, pregnancy, delivery, and treatment with oral contraceptives. Acta Obstet Gynecol Scand. 1982; 61(5):417-22.
28. Howie P W, Calder A A, Forbes C D, Prentice C R M. Effect of intravenous prostaglandin E2 on platelet function, coagulation and fibrinolysis. J Clin. Path. 1973; 26:345-358.
