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GnRH Antagonist Protocol Enhances Coagulation During Controlled Ovarian Stimulation for IVF. Reprod Sci 2022; 29:3521-3531. [PMID: 35821349 DOI: 10.1007/s43032-022-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022]
Abstract
Changes in coagulation and fibrinolysis have been reported in women undergoing controlled ovarian hyperstimulation (COH) supporting a potential hypercoagulable condition related to this treatment. This study aimed at evaluating the changes in fibrin clot properties and thrombin generation induced by two different COH protocols: long with gonadotropin-releasing hormone agonist (GnRH-a) and GnRH antagonist (GnRH-ant). Primary outcomes included determination of plasma fibrin clot properties, including clot permeability (Ks) and efficiency of fibrinolysis using clot lysis time (CLT), along with thrombin generation (prothrombin fragments 1 + 2) and endogenous thrombin potential (ETP) and fibrinolysis inhibitor levels. One hundred twenty-nine infertile women were included in the final analysis. The GnRH-ant protocol resulted in increased ETP (+ 9.8%) and reduced Ks (- 2.4%). Conversely, COH with the GnRH-a protocol reduced thrombin generation by decreasing both ETP (- 6.6%) and F1 + 2 (- 30.8%) together with favorably altered fibrin clot properties represented by increased Ks (+ 21.7%) and reduced CLT (- 13.8%) as well as decreased PAI-1 levels (by 2.5 times). The GnRH-ant compared to the GnRH-a protocol increased PAI-1 levels (+ 77.3%), thrombin generation (9.3% higher ETP), and Ks (+ 13.7%). In the GnRH-a group, post-COH Ks was 14.3% higher (Ks ≥ 7.92 × 10-9 cm2) in women with positive vs. negative pregnancy outcomes. Our results show that the GnRH-ant protocol enhanced thrombin generation and slightly decreased fibrin clot density. COH with the GnRH-a reduced thrombin generation and improved fibrin clot features. This trial was registered (NCT04166825). Clinical Trial Registration Number: NCT04166825.
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de Souza MDGC, Maranhão PA, Panazzolo DG, Nogueira Neto JF, Bouskela E, Kraemer-Aguiar LG. Effects of a high-fat meal on inflammatory and endothelial injury biomarkers in accordance with adiposity status: a cross-sectional study. Nutr J 2022; 21:65. [PMID: 36258233 PMCID: PMC9580189 DOI: 10.1186/s12937-022-00819-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/22/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background It is known that consuming a high-fat meal (HFM) induces microvascular dysfunction (MD) in eutrophic women and aggravates it in those with obesity. Our purpose was to investigate if the MD observed after a single HFM intake is caused by endothelial damage or increased inflammatory state, both determined by blood biomarkers. Methods Nineteen women with obesity (BMI 30-34.9 kg/m2) and 18 eutrophic ones (BMI 20.0-24.9 kg/m2) were enrolled into two groups: Obese (OBG) and Control (CG), respectively. Blood samples were collected at five-time points: before (fasting state) and 30, 60, 120, and 180 min after HFM intake to determine levels of adipokines (adiponectin, leptin), non-esterified fatty acid (NEFA), inflammatory [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)] and endothelium damage [soluble E-selectin, soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), plasminogen activator inhibitor-1 (PAI-1)] biomarkers. Results Levels of soluble E-selectin, leptin, and PAI-1 were higher in OBG at all-time points (P < 0.05) compared to CG. In the fasting state, OBG had higher levels of NEFA compared to CG (P < 0.05). In intra-group analysis, no significant change in the levels of circulating inflammatory and endothelial injury biomarkers was observed after HFM intake, independently of the group. Conclusion Our findings suggest that women with obesity have an increased pro-inflammatory state and more significant endothelial injury compared to eutrophic ones. However, the consumption of a HFM was not sufficient to change circulating levels of inflammatory and endothelial injury biomarkers in either group. Registration number for clinical trials: NCT01692327.
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Affiliation(s)
- Maria das Graças Coelho de Souza
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro (UERJ), 20550- 013, Rio de Janeiro, RJ, Brazil
| | - Priscila Alves Maranhão
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro (UERJ), 20550- 013, Rio de Janeiro, RJ, Brazil.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - Diogo Guarnieri Panazzolo
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro (UERJ), 20550- 013, Rio de Janeiro, RJ, Brazil
| | - José Firmino Nogueira Neto
- Lipids Laboratory (Lablip), State University of Rio de Janeiro (UERJ), Policlínica Piquet Carneiro, 20550-003, Rio de Janeiro, RJ, Brazil
| | - Eliete Bouskela
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro (UERJ), 20550- 013, Rio de Janeiro, RJ, Brazil.,Obesity Unit, Centro de Pesquisa Clínica Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro (UERJ), 20551-030, Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro (UERJ), 20550- 013, Rio de Janeiro, RJ, Brazil. .,Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), 20551-170, Rio de Janeiro, RJ, Brazil. .,Obesity Unit, Centro de Pesquisa Clínica Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro (UERJ), 20551-030, Rio de Janeiro, RJ, Brazil.
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Alzahrani F, Hassan F. Modulation of Platelet Functions Assessment during Menstruation and Ovulatory Phases. J Med Life 2019; 12:296-300. [PMID: 31666834 PMCID: PMC6814885 DOI: 10.25122/jml-2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
During menstruation, endometrial hemostasis is achieved by platelet aggregation, fibrin deposition, and thrombus formation that interact with local endocrine and immunological factors which cause termination of menstrual bleeding. Interactions between steroidal sex hormones and platelet functions are not well understood. The aim of this study was to evaluate the effect of platelet function during the menstrual cycle and luteal phase in women of reproductive age. The cross-sectional study on women of reproductive age included 44 healthy women. Platelet function was assessed by PFA-100TM analyzer with collagen/epinephrine and collagen/ADP cartridges during the menstrual cycle and luteal phase. There were no significant differences in platelet function between menstruation and ovulatory phase. Platelet activity in Arab collagen/epinephrine cartridge increased during menstruation compared to non-Arab ethnic subjects and no significant differences in platelet function were found when using collagen/ADP cartridge. This study suggested modulation in platelet functions during menstruation and luteal phase in women of reproductive age. Further studies, including a large number of subjects, platelet genetic and progesterone factors change in platelet clotting associated to menstrual cycle should be conducted.
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Affiliation(s)
- Faisal Alzahrani
- Department of Clinical Laboratory Science, Imam Abdulrahman Bin Faisal University, College of Applied Medical Science, Dammam, Saudi Arabia
| | - Fathelrahman Hassan
- Department of Clinical Laboratory Science, Imam Abdulrahman Bin Faisal University, College of Applied Medical Science, Dammam, Saudi Arabia
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Balandina AN, Koltsova EM, Teterina TA, Yakovenko AG, Simonenko EU, Poletaev AV, Zorina IV, Shibeko AM, Vuimo TA, Yakovenko SA, Ataullakhanov FI. An enhanced clot growth rate before in vitro fertilization decreases the probability of pregnancy. PLoS One 2019; 14:e0216724. [PMID: 31120933 PMCID: PMC6532853 DOI: 10.1371/journal.pone.0216724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background The shift towards hypercoagulation during in vitro fertilization (IVF) can lead to the impairment of embryo implantation and placental blood circulation, which is believed to be a factor in an unsuccessful IVF cycle. Objectives To assess coagulation in women with infertility before the start of an IVF cycle and during treatment to reveal the association between coagulation imbalance and IVF outcome. Patients/Methods We conducted a prospective cohort observational study including 125 participants who underwent fresh IVF cycles. Blood samples were collected at five time points: before IVF, one week after the start of controlled ovarian stimulation (COS), on the day of follicular puncture, on the day of embryo transfer (ET) and one week after ET. Coagulation tests (clotting times: activated partial thromboplastin time (APTT) and prothrombin; fibrinogen and D-dimer concentrations; thrombodynamics) were performed. Results Women with an elevated clot growth velocity (>32.3 μm/min, detected by thrombodynamics) before IVF demonstrated a higher risk of negative IVF outcomes (adjusted RR = 1.38; 95% CI 1.28–1.49; P<0.001). During the procedure, we observed increases in prothrombin, fibrinogen and D-dimer concentrations, a slight shortening of APTT and a hypercoagulation shift in the thrombodynamics parameters. The hemostasis assay values during COS and after ET had no associations with IVF outcomes. Conclusions Hypercoagulation in the thrombodynamics before the start of IVF treatment was associated with negative IVF outcomes. After the start of COS, all tests demonstrated a hypercoagulation trend, but the hypercoagulation did not influence IVF outcome. This research is potentially beneficial for the application of thrombodynamics assay for monitoring hemostasis in infertile women prior to an IVF procedure with the goal of selecting a group requiring hemostasis correction to increase the chances of pregnancy.
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Affiliation(s)
- A. N. Balandina
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
- * E-mail:
| | - E. M. Koltsova
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
| | | | | | | | - A. V. Poletaev
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | | | - A. M. Shibeko
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
| | - T. A. Vuimo
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
| | - S. A. Yakovenko
- AltraVita IVF clinic, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
| | - F. I. Ataullakhanov
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia
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Govorov I, Bremme K, Lindahl TL, Holmström M, Komlichenko E, Chaireti R, Mints M. Thrombin generation during a regular menstrual cycle in women with von Willebrand disease. Sci Rep 2018; 8:17467. [PMID: 30504807 PMCID: PMC6269516 DOI: 10.1038/s41598-018-35897-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/07/2018] [Indexed: 11/09/2022] Open
Abstract
Fluctuations of the sex steroids during the menstrual cycle might significantly influence hemostasis. This association, derived from a number of the observations on healthy women, is yet to be described in females affected by bleeding disorders. The aim of the current study was to assess the changes in hemostatic variables in women with vWD during two phases of the menstrual cycle (follicular and luteal) and to compare it with healthy controls. The study group included 12 vWD-affected females with regular menstrual cycle, with none of them being prescribed any hormonal treatment. The control group consisted of 102 healthy females, matched for age and BMI. Within the vWD group FVIII and FX were both significantly higher during follicular phase than in luteal phase (p = 0.013 and p = 0.033 respectively). AT, FII, FVII and FX were higher in women with vWD, compared with controls during both phases of the menstrual cycle (p < 0.0005, p < 0.0005, p = 0.001 and p < 0.0005). In women with vWD, lag time and time to peak were prolonged during both phases of the menstrual cycle(p < 0.0005), while peak thrombin concentration was reduced (p = 0.003 and p = 0.002 during follicular and luteal phase respectively) compared to healthy peers. Lower levels of FVIII and FX during luteal phase may predispose women to the development of the menorrhagia - common complication of vWD. Women with vWD need more time to reach the peak thrombin concentration, while the latter still remains less than in healthy women. Higher levels of AT in vWD-affected females, compared to controls, may also contribute to the existing bleeding tendency in this cohort.
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Affiliation(s)
- Igor Govorov
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Katarina Bremme
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tomas L Lindahl
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Margareta Holmström
- Department of Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Eduard Komlichenko
- Institution of Pediatrics and Perinatology, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Roza Chaireti
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Yamanaka A, Kimura F, Yoshida T, Kita N, Takahashi K, Kushima R, Murakmai T. Dysfunctional coagulation and fibrinolysis systems due to adenomyosis is a possible cause of thrombosis and menorrhagia. Eur J Obstet Gynecol Reprod Biol 2016; 204:99-103. [DOI: 10.1016/j.ejogrb.2016.07.499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/12/2016] [Accepted: 07/26/2016] [Indexed: 11/16/2022]
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Li C, Yang M, Wang C, Wang C, Fan J, Chen Z, Wei X, Zhang G, Bai Y, Zhu X, Xie Y, Li M. Preoperative factors predicting intraoperative blood loss in female patients with adolescent idiopathic scoliosis. Medicine (Baltimore) 2015; 94:e359. [PMID: 25569653 PMCID: PMC4602827 DOI: 10.1097/md.0000000000000359] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this article, a retrospective analysis of 161 female patients with adolescent idiopathic scoliosis (AIS) is performed who underwent posterior correction and fusion using all-pedicle screw instrument.The aim of this article is to find out preoperative factors that influence intraoperative blood loss (IOBL) in female patients with AIS.The IOBL in posterior correction and fusion surgery for patients with idiopathic scoliosis greatly varies. The variables affecting the IOBL also greatly vary among different studies.Medical records of all female patients with AIS who underwent posterior correction and fusion operations using the all-pedicle screw system in our hospital from January 2012 to January 2014 were reviewed. Patients with irregular menstruation, who underwent osteotomy, and using coagulants were excluded. Preoperative clinical data, including patient age, height, weight, Risser sign, day after last menstruation, major curve Cobb angle, fulcrum-bending Cobb angle, curve flexibility index, sagittal thoracic Cobb angle, sagittal lumbar Cobb angle, albumin, hemoglobin, platelet, activated partial thromboplastic time (APTT), prothrombin time, thrombin time, fibrinogen, fusion level, menstrual phase, and blood type, were collected. Data were further analyzed using multiple linear regression with forward elimination.A total of 161 patients were included in this study. The mean IOBL was 933.98 ± 158.10 mL (500-2000 mL). Forward selection showed that fulcrum-bending Cobb angle, fusion level, Risser sign, APTT, fibrinogen, and menstrual phase were the preoperative factors that influenced the IOBL in female patients with AIS. Equation of IOBL was built by multiple linear regression: IOBL = -966.228 + 54.738 Risser sign + 18.910 fulcrum-bending Cobb angle + 114.737 fibrinogen + 21.386 APTT - 71.312 team 2 - 177.985 team 3 - 165.082 team 4 + 53.470 fusion level. R = 0.782.Operation for patients with AIS was featured by large IOBL. Large fulcrum-bending Cobb angle, the number of level fused, higher Risser sign, high APTT, high preoperative blood fibrinogen concentration, and premenstrual phase predicted higher IOBL.
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Affiliation(s)
- Chao Li
- From the Department of Spine Surgery (CL, MY, JF, ZC, XW, GZ, YB, XZ, ML); Department of Orthopedics (Chuanfeng W, YX), Changhai Hospital, Shanghai; and Department of Orthopedic Injury (Chao W), General Hospital of Jinan Military Area, Jinan, China
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Li C, Xie Y, Li Z, Yang M, Sun X, Fan J, Zhu HYX, Wang C, Li M. Intraoperative blood loss in female patients with adolescent idiopathic scoliosis during different phases of the menstrual cycle. PLoS One 2014; 9:e112499. [PMID: 25422893 PMCID: PMC4244093 DOI: 10.1371/journal.pone.0112499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The vast majority of AIS patients who require surgical intervention are women. Blood loss is a major concern during the operation. METHODS The medical records of all female AIS patients who underwent posterior correction and fusion operations using the all-pedicle screw system from January 2012 to January 2014 were reviewed. Patients with irregular menstruation; underwent osteotomy; use coagulants were excluded from the study. The remaining patients were divided into 4 groups according to the operation date in the menstrual cycle (A: premenstrual group, 24-30 d; B: follicle group, 6-11 d; C: ovulatory group, 12-17 d; D: luteal group, 18-23 d). The information of patients from the 4 groups was reviewed. The data was analyzed using analysis of variance, the Student-Newman-Keels test and Kruskal-Wallis Test. RESULTS A total of 161 patients were included in this study. There were 40 patients included in group A, 38 patients in group B, 41 patients in group C and 42 patients in group D. The 4 groups were matched in age (P = 0.238), body height (P = 0.291), body weight (P = 0.756), Risser sign (P = 0.576), mean curve Cobb angle (P = 0.520), and bending flexibility index (P = 0.547), the number of levels fused (P = 0.397). The activated partial thromboplastin time (P = 0.235) and prothrombin time (P = 0.074) tended to be higher in group A, but the difference was not statistically significant. The fibrinogen level was lower in group B than the other 3 groups (P = 0.039). Blood loss and normalized intraoperative blood loss (NBL) was significantly higher in group A than the other 3 groups (P<0.01). CONCLUSIONS The hemostatic function tended to be lower in the premenstrual phase. The fibrinogen level was lowest in the mid-follicle phase. Female AIS patients tended to endure more intraoperative blood loss when the operation was performed in the premenstrual phase during the menstrual cycle.
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Affiliation(s)
- Chao Li
- Department of Spine Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Yang Xie
- Department of Orthopedics, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhikun Li
- Department of Spine Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Mingyuan Yang
- Department of Spine Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Xiaofei Sun
- Department of Spine Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Jianping Fan
- Department of Spine Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | | | - Chuanfeng Wang
- Department of Orthopedics, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Ming Li
- Department of Spine Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
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Changes in haemostatic parameters during the menstrual cycle and subsequent use of drospirenone-containing oral contraceptives. Thromb Res 2014; 134:1032-7. [DOI: 10.1016/j.thromres.2014.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/03/2014] [Accepted: 09/07/2014] [Indexed: 11/21/2022]
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Wiewel-Verschueren S, Knol HM, Lisman T, Bogchelman DH, Kluin-Nelemans JC, van der Zee AGJ, Mulder AB, Meijer K. No increased systemic fibrinolysis in women with heavy menstrual bleeding. J Thromb Haemost 2014; 12:1488-93. [PMID: 24954113 DOI: 10.1111/jth.12645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of heavy menstrual bleeding. OBJECTIVE To investigate fibrinolytic parameters, including clot lysis time, in women with heavy menstrual bleeding. METHODS We included 102 patients referred for heavy menstrual bleeding (Pictorial Bleeding Assessment Chart score of > 100) in our cohort. Patients and controls (28 healthy volunteers without heavy menstrual bleeding) underwent hemostatic testing in the first week after menstruation. For 79 patients and all controls, fibrinolytic parameters (thrombin-activatable fibrinolysis inhibitor activity, and plasminogen activator inhibitor-1, tissue-type plasminogen activator and plasmin inhibitor levels) and clot lysis time were available. RESULTS Fibrinolytic parameters were similar between patients and controls, except for thrombin-activatable fibrinolysis inhibitor (89.4% vs. 82.5%) and plasmin inhibitor (106% vs. 96%), the levels of which which were significantly higher in patients. In women with menorrhagia without gynecologic abnormalities, we found lower thrombin-activatable fibrinolysis inhibitor and plasminogen activator inhibitor-1 levels than in women with gynecologic abnormalities (thrombin-activatable fibrinolysis inhibitor, 85.4% vs. 94.8%; plasminogen activator inhibitor-1, 16.0 μg L(-1) vs. 24.5 μg L(-1) ). CONCLUSION Systemic fibrinolytic capacity is not increased in women with heavy menstrual bleeding. Overall, levels of the fibrinolytic inhibitors thrombin-activatable fibrinolysis inhibitor and plasmin inhibitor were even higher in patients than in controls. However, in a subgroup of women without gynecologic abnormalities, relatively lower levels of inhibitors may contribute to the heavy menstrual bleeding.
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Affiliation(s)
- S Wiewel-Verschueren
- Division of Hemostasis and Thrombosis, Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Hill AM, Stewart PW, Fung MK, Kris-Etherton PM, Ginsberg HN, Tracy RP, Pearson TA, Lefevre M, Reed RG, Elmer PJ, Holleran S, Ershow AG. Monthly haemostatic factor variability in women and men. Eur J Clin Invest 2014; 44:309-18. [PMID: 24382103 PMCID: PMC4153833 DOI: 10.1111/eci.12235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 12/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hormonal status influences haemostatic factors including fibrinogen, factor VII and plasminogen activator inhibitor (PAI-1), and concentrations differ among men, premenopausal and postmenopausal women. This study examines how phases of the menstrual cycle influence variability of fibrinogen, factor VII and PAI-1. DESIGN We studied 103 subjects (39 premenopausal women, 18 postmenopausal women and 46 men) during three, randomized, 8-week energy- and nutrient-controlled experimental diets in the Dietary Effects on Lipids and Thrombogenic Activity (DELTA) Study. Fasting blood samples were collected weekly during the last 4 weeks of each diet period, and haemostatic factors were quantified. Two linear mixed-effects models were used for fibrinogen, factor VII and PAI-1: one to estimate and compare group-specific components of variance, and the other to estimate additional fixed effects representing cyclical functions of day of menstrual cycle in premenopausal women. RESULTS Systematic cyclical variation with day of menstrual cycle was observed for fibrinogen (P < 0.0001), factor VII (P = 0.0012) and PAI-1 (P = 0.0024) in premenopausal women. However, the amplitude of cycling was small relative to the total magnitude of intra-individual variability. In addition, the intra-individual variance and corresponding coefficient of variation observed in premenopausal women did not differ from postmenopausal women and men. CONCLUSIONS The variability in haemostatic factors in premenopausal women is no greater than for postmenopausal women or men. Consequently, premenopausal women can be included in studies investigating haemostatic factor responses without controlling for stage of menstrual cycle.
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Affiliation(s)
- Alison M Hill
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA; Nutritional Physiology Research Centre, The University of South Australia, Adelaide, Australia
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12
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Chaireti R, Gustafsson KM, Byström B, Bremme K, Lindahl TL. Endogenous thrombin potential is higher during the luteal phase than during the follicular phase of a normal menstrual cycle. Hum Reprod 2013; 28:1846-52. [PMID: 23592222 DOI: 10.1093/humrep/det092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do thrombin generation and haemostatic parameters differ during the two phases of the menstrual cycle? SUMMARY ANSWER Total thrombin concentration is higher during the luteal phase compared with the follicular phase of the menstrual cycle. WHAT IS KNOWN ALREADY The coagulation cascade is affected by many variables, such as fluctuations in the levels of sex hormones. The studies on the variations in haemostatic parameters during the menstrual cycle have produced diverse results. STUDY DESIGN, SIZE, DURATION Thrombin generation and selected haemostatic parameters (fibrinogen, factor II, factor VII, factor VIII, factor X, von Willebrand factor, antithrombin and D-dimer) were measured during the two phases of a normal menstrual cycle in 102 healthy women not taking any form of hormone medication. PARTICIPANTS/MATERIALS, SETTING, METHODS The study cohort consisted of 102 healthy women with regular menstrual cycles. Thrombin generation was measured by the calibrated automated thrombogram method. Progesterone and sex hormone-binding globulin were measured by chemiluminescence enzyme immunoassays. Estradiol was measured by a sensitive radioimmunoassay. Fibrinogen was measured by a clotting method, antithrombin was measured by a chromogenic method and factor II, factor VII, factor VIII, factor X, von Willebrand factor and D-dimer were measured by photometric methods. MAIN RESULTS AND THE ROLE OF CHANCE It was shown that the total amount of generated thrombin (Endogenous Thrombin Potential) was significantly higher during the luteal compared with the follicular phase (P = 0.027). Factor X was significantly higher during the follicular phase (P = 0.028). Progesterone exhibited significant associations (measured by the least squares regression analysis) with fibrinogen and factor X during the follicular phase (P = 0.043 and P = 0.033, respectively) and with factors II and VII during the luteal phase (P = 0.034 and P = 0.024, respectively). The validity of the results from the regression analysis was further confirmed by performing correlation analyses (Pearson correlation matrix) for haemostatic markers for the luteal and follicular phases (accepted correlation level >0.8). LIMITATIONS, REASONS FOR CAUTION The wide confidence interval for the differences in endogenous thrombin potential during the two phases could imply that the size of the cohort may not be sufficient to fully evaluate the biological variations. Additionally, the haemostatic markers were not shown to have significant associations with thrombin generation, suggesting that the increased thrombin concentration during the luteal phase would be mediated by another mechanism, as yet unidentified. WIDER IMPLICATIONS OF THE FINDINGS The associations between progesterone and the haemostatic markers, as shown for both phases of the menstrual cycle, suggest a previously unknown or undefined yet potentially significant role for progesterone in the coagulation system. However, it has been shown that the use of progestogen-only preparations does not affect the coagulation system, which is partly the reason why they are considered safe for women with thrombophilia or previous thrombotic event. Further studies are required in order to demonstrate whether our results can be extrapolated for synthetic progestins, which might have significant implication on the indications for their use.
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Affiliation(s)
- R Chaireti
- Department of Acute Internal Medicine and Coagulation Division, Linköping University Hospital, Linköping 581 85, Sweden.
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von Känel R, Natarajan L, Ancoli-Israel S, Mills PJ, Wolfson T, Gamst AC, Loredo JS, Dimsdale JE. Effect of continuous positive airway pressure on day/night rhythm of prothrombotic markers in obstructive sleep apnea. Sleep Med 2013; 14:58-65. [PMID: 23036264 PMCID: PMC3540139 DOI: 10.1016/j.sleep.2012.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/02/2012] [Accepted: 07/26/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) has been associated with an increased risk of atherothrombotic events. A prothrombotic state might partially explain this link. This study investigated OSA patients' day/night rhythm of several prothrombotic markers and their potential changes with therapeutic continuous positive airway pressure (CPAP). METHODS The study included 51 OSA patients [apnea hypopnea index (AHI) ⩾10] and 24 non-OSA controls (AHI<10). Of the 51 OSA patients, 25 were randomized to CPAP and 26 to placebo-CPAP. Twelve blood samples were collected over a 24h period to measure prothrombotic markers. For the apneic patients these samples were collected before treatment and after 3weeks of treatment with either CPAP or placebo-CPAP. Day/night variation in prothrombotic markers was examined using a cosinor analysis. RESULTS Compared with controls, OSA patients showed lower mesor (mean) and amplitude (difference between maximum and minimum activity) of D-dimer. In unadjusted (but not in adjusted) analysis, patients showed higher mesor of plasminogen activator inhibitor-1 (p<0.05 in all cases). No significant group differences were seen in mesor and amplitude for either soluble tissue factor or von Willebrand factor, or the acrophase (time of the peak) and periodic pattern for any prothrombotic markers. There were no significant differences in changes of periodic pattern and in day/night rhythm parameters of prothrombotic markers pre- to post-treatment between the CPAP and placebo condition. CONCLUSIONS There may be altered day/night rhythm of some prothrombotic markers in OSA patients compared with controls. CPAP treatment for 3weeks did not affect day/night rhythm of prothrombotic markers in OSA patients differently from placebo-CPAP.
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Affiliation(s)
- Roland von Känel
- Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland
- Department of Psychiatry, University of California, San Diego, USA
| | - Loki Natarajan
- Department of Family and Preventive Medicine, University of California, San Diego, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, USA
- Department of Medicine, University of California, San Diego, USA
| | - Paul J. Mills
- Department of Psychiatry, University of California, San Diego, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, San Diego, Supercomputer Center University of California, San Diego, USA
| | - Anthony C. Gamst
- Computational and Applied Statistics Laboratory, San Diego, Supercomputer Center University of California, San Diego, USA
| | - José S. Loredo
- Department of Medicine, University of California, San Diego, USA
| | - Joel E. Dimsdale
- Department of Psychiatry, University of California, San Diego, USA
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Knol HM, Kemperman RFJ, Kluin-Nelemans HC, Mulder AB, Meijer K. Haemostatic variables during normal menstrual cycle. A systematic review. Thromb Haemost 2011; 107:22-9. [PMID: 22159564 DOI: 10.1160/th11-07-0481] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/24/2011] [Indexed: 11/05/2022]
Abstract
For a number of haemostatic factors menstrual cycle variation has been studied. Such variation could have clinical implications for the timing of haemostatic testing in women. It was our objective to systematically review the literature about evidence for timing of haemostatic testing during menstrual cycle.We searched MEDLINE, EMBASE and the Cochrane library to identify studies that measured haemostatic variables [platelet function, von Willebrand factor (VWF), factor VIII (FVIII), factor IX (FIX), factor XI (FXI), factor XIII (FXIII), D-dimer, plasminogen activator inhibitor-I (PAI-I), tissue plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), α2-antiplasmin and fibrinogen] during normal menstrual cycle without hormonal contraceptives. Two investigators independently selected studies, and abstracted data in duplicate. We identified 1,046 studies of which we included 30 studies (25 longitudinal and 5 cross-sectional studies). All studies reported on haemostatic variables during menstrual cycle. Overall, most of the studies found no cyclic variation in VWF, FVIII, FXI, FXIII, fibrinolytic factors (PAI, t-PA, uPA, D-dimer and α2-antiplasmin) and fibrinogen. However, in studies where these variables showed any variation, they reached the lowest levels during menstrual and early follicular phase, especially for VWF, FVIII and platelet function tests. In conclusion, the optimal timing for haemostatic testing during menstrual cycle seems to be menstrual and early follicular phase.
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Affiliation(s)
- H Marieke Knol
- Marieke Knol, MD, Division of Haemostasis and Thrombosis, Department of Haematology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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Koh SCL, Singh K. Levonorgestrel-intrauterine system effects on hemostasis and menstrual blood loss in women seeking contraception. J Obstet Gynaecol Res 2010; 36:838-44. [PMID: 20666954 DOI: 10.1111/j.1447-0756.2010.01255.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM The purpose of the study is to determine the effects of levonorgestrel use on hemostasis, and menstrual blood loss over 24 months in a cohort of women seeking contraception. METHODS Data from 30 women (median age 36 years) were analyzed. Samplings at pre-insertion, 1 and 3 months for blood and additional endometrial aspirates at 2 and 6 months were performed. Systemic determination for hemoglobin, hematocrit, computerized thromboelastography, tissue-type plasminogen activator, urokinase-like plasminogen activator and receptor, plasminogen activator inhibitor-1/2, D-dimer and von Willebrand Factor was performed. In endometrial extracts, tissue-type plasminogen activator, urokinase-like plasminogen activator and receptor and plasminogen activator inhibitor-1/2 were assayed. The Menstrual Blood Loss Pictorial Chart Score for measurement of menstrual blood loss was carried out for 24 months. RESULTS There were no significant changes in systemic hemostasis within 3 months of device use. In the endometrium, there was a significant increase in tissue-type plasminogen activator antigen, plasminogen activator inhibitor-1/2 and urokinase-like plasminogen activator receptor levels from pre-insertion state, with the highest level seen by 6 months. Amenorrhea was seen in 20% of women by 6 months and 50% by 24 months. CONCLUSIONS Enhanced expression of plasminogen activator inhibitor-1/2 in the presence of increased urokinase-like plasminogen activator receptor and tissue-type plasminogen activator antigen was seen in the endometrium. The effects on hemostasis appear to be localized in the endometrium. Systemic hemostasis was not duly affected and menstrual blood loss was reduced. No women in the study had a pregnancy or expulsion of the levonorgestrel-intrauterine system device in the 24 months of the study period.
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Affiliation(s)
- Stephen C L Koh
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Republic of Singapore.
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van Vliet HA, Rodrigues SP, Snieders MN, van der Meer FJ, Frolich M, Rosendaal FR, Rosing J, Helmerhorst FM. Sensitivity to activated protein C during the menstrual cycle in women with and without factor VLeiden. Thromb Res 2008; 121:757-61. [DOI: 10.1016/j.thromres.2007.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 08/02/2007] [Accepted: 08/20/2007] [Indexed: 11/29/2022]
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Haus E. Chronobiology of hemostasis and inferences for the chronotherapy of coagulation disorders and thrombosis prevention. Adv Drug Deliv Rev 2007; 59:966-84. [PMID: 17822804 DOI: 10.1016/j.addr.2006.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 11/05/2006] [Indexed: 01/09/2023]
Abstract
The hemostatic system in its multiple components displays an intricate organization in time which is characterized by circadian (approximately 24-hour), circaseptan (approximately 7-day), menstrual (approximately monthly), and circannual (approximately yearly) bioperiodicities. The interaction of the rhythms of the variables participating in hemostasis determine transient risk states of thromboembolic events, including myocardial infarction and stroke, and of hemorrhage and hemorrhagic events, each with a unique timing. The circadian staging of the rhythms in vascular, cellular, and coagulation factors that favors blood coagulation and thrombosis coincides with the daily minimum in fibrinolytic activity; as a result there is elevated risk in the morning of acute myocardial infarction and stroke. Similar hemostatic rhythms may determine the epidemiology of thromboembolic and hemorrhagic events during the week, month and year. This article focuses on the large-amplitude circadian rhythms operative in the hemostatic system. Their implication for preventive and curative pharmacotherapy of hemostatic disorders is presented, with discussion of related problems.
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Affiliation(s)
- Erhard Haus
- University of Minnesota, HealthPartners Medical Group, Regions Hospital, St. Paul 55101, USA.
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Koh SCL, Singh K. The effect of levonorgestrel-releasing intrauterine system use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in women with menorrhagia. J Thromb Haemost 2007; 5:133-8. [PMID: 17010149 DOI: 10.1111/j.1538-7836.2006.02243.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Menorrhagia is known to be associated with uterine fibroids, adenomyosis, pelvic infections, endometrial polyps and clotting defects. A viable alternative therapy to hysterectomy should alleviate heavy menstrual blood flow and consequently improve the quality-of-life measures in women presenting with menorrhagia. The levonorgestrel-releasing intrauterine system (LNG-IUS) ranks higher than medical treatments in terms of efficacy, comparable improvements in quality of life and psychological well-being. OBJECTIVE The purpose of the study was to determine the effects of 6 months of LNG-IUS use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in blood and the endometrium in women with menorrhagia with known pathologic causes. PATIENTS AND METHODS Samples from 41 women were analyzed. Hemoglobin, hematocrit, thrombelastography, tissue-type plasminogen activator (t-PA), urokinase plasminogen activator (u-PA), u-PA receptor (u-PAR), plasminogen activator inhibitor-1/2 (PAI-1/2), D-dimer and von Willebrand factor (VWF) were determined, and t-PA, u-PA and PAI-1/2 were also determined in endometrial tissue extracts. RESULTS Menorrhagia was reduced in 89% of women by 3 months; by 6 months all women had no menorrhagia, and 39% of women had become amenorrhoeic. Hemoglobin and hematocrit levels showed improvement, and reached normal reference levels by 6 months. There were no systemic changes in the fibrinolytic/inhibitor systems and VWF, except for a decreased u-PAR level. However, in the endometrium, significant elevations in PAI-1/2 together with u-PAR levels were seen at 6 months. CONCLUSIONS The slow levonorgestrel-release intrauterine device use results in high expression of fibrinolytic inhibitors (PAI-1/2) and upregulated u-PAR expression in the endometrium. Systemic hemostasis was not significantly altered. The study demonstrated that LNG-IUS is highly effective in the treatment of menorrhagia with known pathologic causes.
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MESH Headings
- Adult
- Contraceptives, Oral, Synthetic/administration & dosage
- Contraceptives, Oral, Synthetic/pharmacology
- Contraceptives, Oral, Synthetic/therapeutic use
- Endometrium/drug effects
- Endometrium/metabolism
- Erythrocyte Indices
- Female
- Fibrin Fibrinogen Degradation Products/metabolism
- Fibrinolysis/drug effects
- Follow-Up Studies
- Hematocrit
- Hemostasis/drug effects
- Humans
- Intrauterine Devices, Medicated
- Levonorgestrel/administration & dosage
- Levonorgestrel/pharmacology
- Levonorgestrel/therapeutic use
- Longitudinal Studies
- Menorrhagia/blood
- Menorrhagia/drug therapy
- Menorrhagia/metabolism
- Menorrhagia/physiopathology
- Menstruation/drug effects
- Middle Aged
- Plasminogen Activator Inhibitor 1/blood
- Plasminogen Activator Inhibitor 1/metabolism
- Plasminogen Activator Inhibitor 2/blood
- Plasminogen Activator Inhibitor 2/metabolism
- Plasminogen Activators/blood
- Plasminogen Activators/metabolism
- Receptors, Cell Surface/blood
- Receptors, Cell Surface/metabolism
- Receptors, Urokinase Plasminogen Activator
- Thrombelastography
- Time Factors
- Treatment Outcome
- von Willebrand Factor/metabolism
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Affiliation(s)
- S C L Koh
- Department of Obstetrics and Gynaecology, National University of Singapore, Yong Loo Lin School of Medicine, National University Hospital, Singapore, Singapore.
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