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Mohammadi K, Ansari R, Yaribash S. Hypersensitivity reaction to rivaroxaban with a successful switch to apixaban: A case report. Clin Case Rep 2024; 12:e9213. [PMID: 39055089 PMCID: PMC11266429 DOI: 10.1002/ccr3.9213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/07/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024] Open
Abstract
Key Clinical Message The precise management of hypersensitivity reactions to direct oral anticoagulants (DOACs) and the potential for cross-reactivity among different DOACs remain unclear. In such cases, switching between DOACs may be feasible and could be considered, but close monitoring for adverse effects is essential, tailored to individual patient responses and tolerability. Abstract Hypersensitivity reactions to DOACs, though considered rare, have been documented. This report describes the case of a 28-year-old male with a history of testicular cancer who was recently diagnosed with deep vein thrombosis. He was referred to an outpatient pharmacotherapy clinic due to suspected rivaroxaban-induced cutaneous reactions. Following a thorough evaluation, his anticoagulant therapy was switched from rivaroxaban to apixaban. This change was successfully implemented, and no hypersensitivity symptoms recurred during subsequent follow-up. This case demonstrates the importance of recognizing potential adverse reactions to DOACs and illustrates the feasibility of switching anticoagulants under close medical supervision to ensure patient safety and effective treatment.
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Affiliation(s)
- Keyhan Mohammadi
- Department of Clinical Pharmacy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Ramin Ansari
- Department of Clinical Pharmacy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
| | - Shakila Yaribash
- Faculty of PharmacyTehran University of Medical SciencesTehranIran
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2
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Gumbis G, Česnavičiūtė I, Didžiokaitė G, Gegeckienė D, Kvedarienė V. Suspected Rivaroxaban-Induced Anaphylaxis Secondary to Ingestion of Rivaroxaban and Nimesulide Without Cross-Reactivity to Dabigatran - A Case Report. J Asthma Allergy 2023; 16:1133-1138. [PMID: 37841493 PMCID: PMC10573425 DOI: 10.2147/jaa.s413057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 10/17/2023] Open
Abstract
Here, we describe a case of anaphylaxis secondary to rivaroxaban in a 61-year-old woman 24 hours after orthopedic surgery. 10-15 minutes after ingestion of rivaroxaban and nimesulide, the patient's palms started itching, her face and lips swelled, her face flushed, she developed shortness of breath and subsequently lost consciousness. Serum tryptase levels at the time of the anaphylactic reaction were elevated, with subsequent measurement one month later returning a value within the normal range. Dabigatran and meloxicam were identified as suitable alternative drugs by oral provocation at an allergy clinic. Even though rivaroxaban rarely causes serious allergic reactions, when prescribing it, it is important to analyze patients' medical history for possible previously experienced drug-induced allergic reactions and to be aware of the risks of possible undesired drug interactions.
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Affiliation(s)
| | | | - Gabija Didžiokaitė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University, Vilnius, Lithuania
| | - Daiva Gegeckienė
- Centre of Cardiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Violeta Kvedarienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Innovative Allergology, Vilnius, Lithuania
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3
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Acute Generalized Exanthematous Pustulosis following SARS-CoV-2 Virus: Remdesivir as a Suspected Culprit. Case Rep Med 2022; 2022:9880827. [PMID: 35991338 PMCID: PMC9385380 DOI: 10.1155/2022/9880827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 11/28/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is an exanthematous condition, predominantly occurring as a result of drug reactions. We, hereby, present the first case of AGEP following treatment with remdesivir in a patient with COVID-19, without hydroxychloroquine use, which serves as a reminder to consider remdesivir as a possible causative agent when dealing with AGEP presentation in COVID patients.
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4
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Wu Z, Ma Y. Hypersensitivity Reaction from Rivaroxaban. Am J Med Sci 2020; 361:679-680. [PMID: 33773756 DOI: 10.1016/j.amjms.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 02/05/2023]
Affiliation(s)
- ZhouPeng Wu
- Department of vascular surgery, West China Hospital, 37 GuoXue Alley, Chengdu 610041, Sichuan Province, China
| | - Yukui Ma
- Department of vascular surgery, West China Hospital, 37 GuoXue Alley, Chengdu 610041, Sichuan Province, China.
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5
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Chohan SA, Balasubramanian D, Ee S. Bullous pemphigoid-like skin rash associated with Rivaroxaban use in a very elderly patient with multimorbidity and chronic kidney disease: A case report. Clin Case Rep 2020; 8:725-730. [PMID: 32274046 PMCID: PMC7141729 DOI: 10.1002/ccr3.2757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/06/2020] [Accepted: 01/25/2020] [Indexed: 12/19/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are increasingly being used in the elderly population in view of its ease of use, efficacy, and favorable side-effect profile compared with the vitamin K antagonists. However, there is a need for increase awareness of well-characterized cases, albeit a small number, of bullous pemphigoid-like skin reactions associated with rivaroxaban.
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Affiliation(s)
| | | | - Samuel Ee
- Changi General HospitalSingaporeSingapore
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Rudd KM, Panneerselvam N, Patel A. Rash associated with rivaroxaban use. Am J Health Syst Pharm 2018; 75:347-349. [DOI: 10.2146/ajhp160985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Kelly M. Rudd
- Department of Pharmaceutical Care, Pharmacology, and Pharmacotherapy, Section of Clinical Pharmacy, Bassett Medical Center, Cooperstown, NY
| | | | - Anush Patel
- Departments of Hematology/Oncology and Medicine, Bassett Medical Center, Cooperstown, NY
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7
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Non-hemorrhage-related adverse effects of rivaroxaban. ACTA ACUST UNITED AC 2017; 2:e108-e112. [PMID: 29379891 PMCID: PMC5777473 DOI: 10.5114/amsad.2017.72533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 02/07/2023]
Abstract
The direct oral anticoagulant rivaroxaban is useful in various indications that include venous deep vein thrombosis prophylaxis/treatment after knee/hip replacement surgery and prevention of stroke in patients with non-valvular atrial fibrillation. Its mechanism of action has been mostly associated with hemorrhage-related adverse effects; thus a number of non-hemorrhage-related adverse effects of the drug have received less attention or go unrecognized. These adverse effects mainly include liver injury, hypersensitivity reactions, leukocytoclastic vasculitis and hair loss. Clinicians should be aware of these rare adverse reactions and advise their patients to contact them as soon as they observe any unexpected clinical response.
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8
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Chiasson CO, Canneva A, Roy FO, Doré M. Rivaroxaban-Induced Hypersensitivity Syndrome. Can J Hosp Pharm 2017; 70:301-304. [PMID: 28894315 DOI: 10.4212/cjhp.v70i4.1681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Charles-Olivier Chiasson
- , PharmD, MSc, was, at the time this manuscript was originally prepared, a Pharmacy Resident at the McGill University Health Centre and a student in the Faculty of Pharmacy, Université de Montreal, Montréal, Quebec. He is now a Pharmacist at the Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec
| | - Arnaud Canneva
- , PharmD, MSc, was, at the time this manuscript was originally prepared, a Pharmacy Resident at the McGill University Health Centre and a student in the Faculty of Pharmacy, Université de Montreal, Montréal, Quebec. He is now a Pharmacist with the Montreal Heart Institute, Montréal, Quebec
| | - François-Olivier Roy
- , PharmD, MSc, was, at the time this manuscript was originally prepared, a Pharmacy Resident at the Hôpital du Sacré-Coeur de Montréal and a student in the Faculty of Pharmacy, Université de Montreal, Montréal, Quebec. He is now a Pharmacist at Hotel-Dieu d'Arthabaska, Victoriaville, Quebec
| | - Maxime Doré
- , BSc, BPharm, MSc, is a Pharmacist at the Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec
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Sasson E, James M, Russell M, Todorov D, Cohen H. Probable Rivaroxaban-Induced Full Body Rash: A Case Report. J Pharm Pract 2017; 31:503-506. [PMID: 28803520 DOI: 10.1177/0897190017722872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Rivaroxaban is a novel oral anticoagulant with several indications, one of which is for stroke prevention in nonvalvular atrial fibrillation. We present a case of probable rivaroxaban-induced rash. CASE SUMMARY A 79-year-old female with a medical history of atrial fibrillation experienced a stroke, after which she was prescribed rivaroxaban 20 mg. After several days, she developed a rash requiring admission to the emergency department and several days of treatment. The rash resolved and she was switched from rivaroxaban to apixaban and did not experience any adverse drug events. DISCUSSION Onset of symptoms occurred within days of rivaroxaban initiation. The patient had no allergy history and never reported a similar reaction while on concurrent home medication regimen. The resolution of rash and toleration of apixaban suggest a rivaroxaban-specific reaction. The mechanism of this rash is currently unclear. CONCLUSION We report one of the first cases of probable rivaroxaban-induced rash, whereas the patient tolerated apixaban. Further investigation is warranted, but prescribers should be cognizant of this potential issue when choosing a factor Xa inhibitor for anticoagulation.
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Affiliation(s)
- Evan Sasson
- 1 Department of Pharmacy, Kingsbrook Jewish Medical Center, Brooklyn, New York, NY, USA
| | - Marian James
- 1 Department of Pharmacy, Kingsbrook Jewish Medical Center, Brooklyn, New York, NY, USA
| | - Mark Russell
- 2 Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, New York, NY, USA
| | - Darko Todorov
- 1 Department of Pharmacy, Kingsbrook Jewish Medical Center, Brooklyn, New York, NY, USA
| | - Henry Cohen
- 3 Kingsbrook Jewish Medical Center, Brooklyn, New York, NY, USA.,4 Touro College of Pharmacy, New York, NY, USA
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10
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Vu TT, Gooderham M. Adverse Drug Reactions and Cutaneous Manifestations Associated With Anticoagulation. J Cutan Med Surg 2017. [PMID: 28639463 DOI: 10.1177/1203475417716364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anticoagulants are amongst the most commonly prescribed medications worldwide. Although rare, localised and systemic drug reactions have been reported with anticoagulants that can lead to significant morbidity and mortality. Some of the first signs of drug reactions to anticoagulants are cutaneous changes that, when recognised early, can prevent significant complications. Dermatologists should be aware of these changes to make an early and accurate diagnosis. This is particularly important in instances of skin-induced necrosis caused by systemic toxicity to anticoagulants. This review discusses adverse drug reactions to the traditional anticoagulants, warfarin and heparin, and the newer direct oral anticoagulants (DOACs) such as the thrombin inhibitor, dabigatran, and the factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban. In particular, this review provides dermatologists with a framework for early diagnosis and management of patients with drug reactions to anticoagulants and alerts them to potential bleeding complications associated with minor procedures.
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Affiliation(s)
- Trang T Vu
- 1 University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - Melinda Gooderham
- 2 Skin Centre for Dermatology, Peterborough, ON, Canada.,3 Probity Medical Research, Waterloo, ON, Canada.,4 Queen's University, Kingston, ON, Canada
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11
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12
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Hypersensitivity reaction after administration of rivaroxaban (Xarelto). Am J Emerg Med 2016; 34:1325.e1-2. [DOI: 10.1016/j.ajem.2015.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/12/2015] [Indexed: 11/23/2022] Open
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13
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McCarthy S, Foley CC, Dvorakova V, Heffron CCBB, Murphy M. A case of rivaroxaban-induced subacute lupus erythematosus. J Eur Acad Dermatol Venereol 2016; 31:e58-e59. [PMID: 27228969 DOI: 10.1111/jdv.13724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S McCarthy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - C C Foley
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - V Dvorakova
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - C C B B Heffron
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - M Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
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14
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Snyder DJ, Matusik FB. Rivaroxaban-induced serum sickness after total knee arthroplasty. Am J Health Syst Pharm 2015; 72:1567-71. [DOI: 10.2146/ajhp140549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | - F. Bahar Matusik
- Department of Pharmacy Practice and Administration, University of Saint Joseph School of Pharmacy, Hartford, CT
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15
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Mekaj YH, Mekaj AY, Duci SB, Miftari EI. New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag 2015; 11:967-77. [PMID: 26150723 PMCID: PMC4485791 DOI: 10.2147/tcrm.s84210] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite the discovery and application of many parenteral (unfractionated and low-molecular-weight heparins) and oral anticoagulant vitamin K antagonist (VKA) drugs, the prevention and treatment of venous and arterial thrombotic phenomena remain major medical challenges. Furthermore, VKAs are the only oral anticoagulants used during the past 60 years. The main objective of this study is to present recent data on non-vitamin K antagonist oral anticoagulants (NOACs) and to analyze their advantages and disadvantages compared with those of VKAs based on a large number of recent studies. NOACs are novel direct-acting medications that are selective for one specific coagulation factor, either thrombin (IIa) or activated factor X (Xa). Several NOACs, such as dabigatran (a direct inhibitor of FIIa) and rivaroxaban, apixaban and edoxaban (direct inhibitors of factor Xa), have been used for at least 5 years but possibly 10 years. Unlike traditional VKAs, which prevent the coagulation process by suppressing the synthesis of vitamin K-dependent factors, NOACs directly inhibit key proteases (factors IIa and Xa). The important indications of these drugs are the prevention and treatment of deep vein thrombosis and pulmonary embolisms, and the prevention of atherothrombotic events in the heart and brain of patients with acute coronary syndrome and atrial fibrillation. They are not fixed, and dose-various strengths are available. Most studies have reported that more advantages than disadvantages for NOACs when compared with VKAs, with the most important advantages of NOACs including safety issues (ie, a lower incidence of major bleeding), convenience of use, minor drug and food interactions, a wide therapeutic window, and no need for laboratory monitoring. Nonetheless, there are some conditions for which VKAs remain the drug of choice. Based on the available data, we can conclude that NOACs have greater advantages and fewer disadvantages compared with VKAs. New studies are required to further assess the efficacy of NOACs.
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Affiliation(s)
- Ymer H Mekaj
- Institute of Pathophysiology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo ; Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, Prishtina, Kosovo
| | - Agon Y Mekaj
- Clinic of Neurosurgery, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo, Prishtina, Kosovo
| | - Shkelzen B Duci
- Clinic of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Prishtina
| | - Ermira I Miftari
- The Hospital and University Clinical Service of Kosovo, Prishtina, Kosovo
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Hypersensitivity reactions to modern antiplatelet and anticoagulant drugs. ACTA ACUST UNITED AC 2015; 24:58-66. [PMID: 26120548 PMCID: PMC4479548 DOI: 10.1007/s40629-015-0048-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/01/2014] [Indexed: 11/12/2022]
Abstract
Anticoagulation and antiplatelet drugs are among the most commonly used medical drugs. In addition to the long-established heparins, hirudins, coumarins and antiplatelet drugs such as acetylsalicylic acid, numerous novel and predominantly synthetic pharmacologic agents have come onto the market in recent years. These new agents act at various sites in coagulation and have significantly broadened treatment options. Whilst immunological hypersensitivity reactions are on the whole rare, they have a considerable impact on patient management when they do occur. The present overview discusses the currently known hypersensitivity reactions to anticoagulant and antiplatelet agents, with particular attention to the newer substance classes including P2Y12 inhibitors, glycoprotein IIb/IIIb receptor antagonists, direct factor Xa inhibitors and direct thrombin inhibitors.
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Hofmeier KS, Bircher AJ. Hypersensitivitätsreaktionen gegen moderne Thrombozytenaggregationshemmer und Antikoagulanzien. ALLERGO JOURNAL 2015. [DOI: 10.1007/s15007-015-0770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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