1
|
Lundberg TR, Tucker R, McGawley K, Williams AG, Millet GP, Sandbakk Ø, Howatson G, Brown GA, Carlson LA, Chantler S, Chen MA, Heffernan SM, Heron N, Kirk C, Murphy MH, Pollock N, Pringle J, Richardson A, Santos-Concejero J, Stebbings GK, Christiansen AV, Phillips SM, Devine C, Jones C, Pike J, Hilton EN. The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes. Scand J Med Sci Sports 2024; 34:e14581. [PMID: 38511417 DOI: 10.1111/sms.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/10/2024] [Accepted: 02/01/2024] [Indexed: 03/22/2024]
Abstract
The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's "no presumption of advantage" principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of "meaningful competition" is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.
Collapse
Affiliation(s)
- Tommy R Lundberg
- Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ross Tucker
- Department of Sport Science, Institute of Sport and Exercise Medicine, University of Stellenbosch, Stellenbosch, South Africa
| | - Kerry McGawley
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - Alun G Williams
- Manchester Metropolitan Institute of Sport, Manchester Metropolitan University, Manchester, UK
- Institute of Sport, Exercise and Health, University College London, London, UK
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Øyvind Sandbakk
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Glyn Howatson
- Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Water Research Group, North West University, Potchefstroom, South Africa
| | - Gregory A Brown
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, Nebraska, USA
| | | | - Sarah Chantler
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Mark A Chen
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Shane M Heffernan
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Neil Heron
- Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Belfast, UK
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Christopher Kirk
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Marie H Murphy
- Physical Activity for Health Research Centre, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
- Centre for Exercise Medicine, Physical Activity and Health, School of Sport, Ulster University, Belfast, UK
| | - Noel Pollock
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jamie Pringle
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Richardson
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Jordan Santos-Concejero
- Department of Physical Education and Sport, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Georgina K Stebbings
- Manchester Metropolitan Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | | | - Stuart M Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Carwyn Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Jon Pike
- Department of Philosophy, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Emma N Hilton
- School of Biological Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
2
|
Christiansen AV, Frenger M, Chirico A, Pitsch W. Authors' Reply to Petrou & Lazuras: 'Recreational Athletes' Use of Performance-Enhancing Substances: Results from the First European Randomized Response Technique Survey'. Sports Med Open 2023; 9:37. [PMID: 37248404 DOI: 10.1186/s40798-023-00583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023]
Affiliation(s)
| | - Monika Frenger
- Institute for Sport Science, Saarland University, Saarbrücken, Germany
- European Institute for Socioeconomy, Saarbrücken, Germany
| | - Andrea Chirico
- Department of Psychology of Development and Socialization Processes, "Sapienza" University of Rome, Rome, Italy
| | - Werner Pitsch
- Institute for Sport Science, Saarland University, Saarbrücken, Germany
- European Institute for Socioeconomy, Saarbrücken, Germany
| |
Collapse
|
3
|
Heinsvig PJ, Christiansen AV, Ayoubi D, Heisel LS, Lindholst C. Do you get what you see? The illicit doping market in Denmark-An analysis of performance and image enhancing drugs seized by the police over a 1-year period. Drug Test Anal 2023. [PMID: 36932906 DOI: 10.1002/dta.3472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/25/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
This study examines doping products seized by the police in three regional police districts in Denmark from December 2019 to December 2020. The products, often referred to as performance and image-enhancing drugs (PIEDs), are described in relation to the country of origin, manufacturing company, and the active pharmaceutical ingredient (API) stated on the packaging versus the one identified by subsequent chemical analysis. The study also includes a description of the degree of professionalism by which the products appear according to EU requirements. A total of 764 products were seized during the study period. The products originate from 37 countries, mainly located in Asia (37%), Europe (23%), and North America (13%). One hundred ninety-three different manufacturing companies could be identified from the product packaging. The most frequent compound class was the androgenic anabolic steroids, found in 60% of the products. In 25%-34% of the products, either no or an incorrect API relative to the one stated on the product was found. However, only 7%-10% contain either no API or a compound from a different compound class than the one stated. Most products had a professional appearance fulfilling most EU requirements for packaging information. The study shows that many different companies supply PIEDs to the Danish market and that counterfeit and substandard products are widespread. Many products do, however, appear professional to the user giving an impression of a high-quality product. Although many products are substandard, they most often contain an API from the same compound class as the one labeled.
Collapse
Affiliation(s)
- Pia Johansson Heinsvig
- Department of Forensic Medicine, Section for Toxicology and Drug Analysis, Aarhus University, Aarhus N, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Daniel Ayoubi
- Department of Forensic Medicine, Section for Toxicology and Drug Analysis, Aarhus University, Aarhus N, Denmark
| | - Laura Smedegaard Heisel
- Department of Forensic Medicine, Section for Toxicology and Drug Analysis, Aarhus University, Aarhus N, Denmark
| | - Christian Lindholst
- Department of Forensic Medicine, Section for Toxicology and Drug Analysis, Aarhus University, Aarhus N, Denmark
| |
Collapse
|
4
|
Christiansen AV, Frenger M, Chirico A, Pitsch W. Recreational Athletes' Use of Performance-Enhancing Substances: Results from the First European Randomized Response Technique Survey. Sports Med Open 2023; 9:1. [PMID: 36617340 PMCID: PMC9825800 DOI: 10.1186/s40798-022-00548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIM Measuring the prevalence of doping in recreational sport is difficult. However, to fit their initiatives, National Anti-Doping Organizations are interested in knowing the numbers, so their scarce resources are not wasted. The present study aimed to estimate the prevalence of doping and over-the-counter medicine use for performance enhancement among recreational athletes in eight European countries. DESIGN A survey covering + 200 sports aimed at recreational athletes 15 years and older was distributed via social media to sports clubs and individuals in eight European countries. To overcome social desirability bias, we applied indirect questioning by using the Randomized Response Technique and asked for the use of over-the-counter medicine and doping for the year 2019. RESULTS The prevalence of the use of over-the-counter medications for performance enhancement was estimated at 10.4%. We differentiated between the concept of "doping" as the behavior to enhance performance in a certain sport and the concept of "a doper" as a property of a person. The prevalence of dopers in recreational sport was found to be 0.4%, with 3.1% male and 0% female dopers. Responses were separated into four categories: "Artistic sports," "Combat sports," "Games," and "CGS sports" (i.e., sports measured in centimeters, grams, and seconds). The overall prevalence of doping in recreational sports was found to be 1.6%, and the results from Artistic and CGS sports did not differ significantly from this. However, in Games we found an estimated doping prevalence of 6.9%. DISCUSSION The estimates for the prevalence of dopers and doping in this study do not equal Anti-Doping Rule Violations as stipulated by the World Anti-Doping Agency. Still, while doping is not absent in recreational sport in Europe, it appears to be a low frequent phenomenon. Also, the differences in doping prevalence between the sports categories might reflect structural and competition-related differences, rather than differences in the logic of the sporting competition or discipline-related subcultures. CONCLUSION While few recreational athletes appear to use illegal drugs to enhance performance, those who do use them are more often men than women. Yet, 1 in 10 recreational athletes uses over-the-counter medication for performance enhancement and more than 4 out of 10 use medication for other reasons than performance enhancement when doing sports. The highest doping prevalence was found in the sub-category of Games, which can likely be attributed to competition-related differences between the categories. Therefore, research on doping in recreational sports needs tailored approaches to come to a better understanding of the phenomenon.
Collapse
Affiliation(s)
- Ask Vest Christiansen
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Monika Frenger
- grid.11749.3a0000 0001 2167 7588Institute for Sport Science, Saarland University, Saarbruecken, Germany ,European Institute for Socioeconomy, Saarbruecken, Germany
| | - Andrea Chirico
- grid.7841.aDepartment of Psychology of Development and Socialization Processes, “Sapienza” University of Rome, Rome, Italy
| | - Werner Pitsch
- grid.11749.3a0000 0001 2167 7588Institute for Sport Science, Saarland University, Saarbruecken, Germany ,European Institute for Socioeconomy, Saarbruecken, Germany
| |
Collapse
|
5
|
Termansen MB, Christiansen AV, Frische S. SARS-CoV-2 prevalence and transmission in swimming activities: Results from a retrospective cohort study. Scand J Med Sci Sports 2021; 32:242-254. [PMID: 34606662 PMCID: PMC8662273 DOI: 10.1111/sms.14071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022]
Abstract
There is an urgent need for research on the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) causing coronavirus disease 2019 (COVID‐19), as the transmissibility differs between settings and populations. Here we report on a questionnaire‐based retrospective cohort study of the prevalence and transmission of SARS‐CoV‐2 among participants in swimming activities in Denmark in the last 5 months of 2020 during the COVID‐19 pandemic. Eight of 162 swimming activities with a SARS‐CoV‐2 positive participant led to transmission to 23 other participants. Overall, the percentage of episodes leading to transmission was 4.9% (competitive swimming 8.9%; recreational swimming 1.3%). Overall, the incidence rate of transmission was 19.5 participants per 100 000 pool activity hours (corresponding values: 43.5 and 4.7 for competitive and recreational swimming, respectively). Compliance with precautionary restrictions was highest regarding hand hygiene (98.1%) and lowest in distancing personal sports bags (69.9%). As a result of low statistical power, the study showed no significant effect of restrictions. Insight into the risk of transmission of SARS‐CoV‐2 during indoor swimming is needed to estimate the efficiency of restrictive measures on this and other sports and leisure activities. Only when we know how the virus spreads through various settings, optimal strategies to handle the COVID‐19 pandemic can be developed.
Collapse
|
6
|
Møller V, Christiansen AV. Neuro-Doping – a Serious Threat to the Integrity of Sport? NEUROETHICS-NETH 2020. [DOI: 10.1007/s12152-020-09446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Christiansen AV, Vinther AS, Liokaftos D. Outline of a typology of men’s use of anabolic androgenic steroids in fitness and strength training environments*. Drugs: Education, Prevention and Policy 2016. [DOI: 10.1080/09687637.2016.1231173] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ask Vest Christiansen
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark and
| | - Anders Schmidt Vinther
- Department of Health and Culture, Aalborg Antidoping, Aalborg Municipality, Aalborg, Denmark
| | - Dimitris Liokaftos
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark and
| |
Collapse
|
8
|
Christiansen AV, Møller RB. Who is more skilful? Doping and its implication on the validity, morality and significance of the sporting test. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.peh.2016.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Merker L, Häring HU, Christiansen AV, Roux F, Salsali A, Kim G, Meinicke T, Woerle HJ, Broedl UC. Empagliflozin as add-on to metformin in people with Type 2 diabetes. Diabet Med 2015; 32:1555-67. [PMID: 26031566 DOI: 10.1111/dme.12814] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 01/01/2023]
Abstract
AIMS To investigate the long-term efficacy and safety of empagliflozin as add-on to metformin in people with Type 2 diabetes. METHODS Of 637 participants treated with empagliflozin 10 mg, empagliflozin 25 mg, or placebo once daily for 24 weeks, 463 (72.7%) were treated in a double-blind extension trial for ≥ 52 weeks. Prespecified exploratory endpoints included changes from baseline in HbA1c , weight and blood pressure at week 76. RESULTS Compared with placebo, adjusted mean changes from baseline in HbA1c (overall baseline mean ± sd 63 ± 9 mmol/mol [7.9 ± 0.9%]) were -7 mmol/mol [(-0.6%) 95% CI -8, -5 mmol/mol (-0.8, -0.5%); P < 0.001] and -8 mmol/mol [(-0.7%) 95% CI -10, -6 mmol/mol (-0.9, -0.6%); P < 0.001], for empagliflozin 10 mg and 25 mg, respectively. Compared with placebo, adjusted mean changes from baseline in weight were -1.9 kg (95% CI -2.5, -1.3; P < 0.001) and -2.2 kg (95% CI -2.8, -1.6; P < 0.001) for empagliflozin 10 mg and 25 mg, respectively. Empagliflozin led to sustained reductions in systolic blood pressure vs. placebo. Adverse events were reported in 77.7, 80.2 and 72.0% of participants on placebo, empagliflozin 10 mg and empagliflozin 25 mg, respectively. Confirmed hypoglycaemic adverse events (glucose ≤ 3.9 mmol/l and/or event requiring assistance) were reported in 3.4, 4.1 and 4.2% of participants in these groups, respectively. CONCLUSIONS In people with Type 2 diabetes, empagliflozin 10 mg and 25 mg given as add-on to metformin for 76 weeks were well tolerated and led to sustained reductions in HbA1c , weight and systolic blood pressure.
Collapse
Affiliation(s)
- L Merker
- Diabetes- und Nierenzentrum, Dormagen, Germany
| | - H-U Häring
- University of Tübingen, Tübingen, Germany
| | | | - F Roux
- Boehringer Ingelheim France S.A.S., Reims, France
| | - A Salsali
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - G Kim
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - T Meinicke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - H J Woerle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - U C Broedl
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| |
Collapse
|
10
|
Christiansen AV, Gleaves J. What do the humanities (really) know about doping? Questions, answers and cross-disciplinary strategies. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.peh.2014.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
11
|
|
12
|
Christiansen AV, Bojsen-Møller J. “Will steroids kill me if I use them once?” A qualitative analysis of inquiries submitted to the Danish anti-doping authorities. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.peh.2012.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Bojsen-Møller J, Christiansen AV. Use of performance- and image-enhancing substances among recreational athletes: a quantitative analysis of inquiries submitted to the Danish anti-doping authorities. Scand J Med Sci Sports 2011; 20:861-7. [PMID: 19843266 DOI: 10.1111/j.1600-0838.2009.01023.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The use of performance- and image-enhancing drugs/substances (PIED) outside elite sports appears to be increasing, although the current knowledge of the nature of PIED use among recreational athletes is scarce. The present study analyzed enquiries that were submitted to the Danish Anti Doping Agency (ADD) over an 18-month period, to gain knowledge of PIED use among individuals who exercise recreationally in Denmark. One thousand three hundred ninety eight queries were examined with respect to the age and gender of the enquirer, affiliation to sport or exercise and substance in question. The key findings were that the ADD information service is generally used by males in their mid-20s who exercise in gyms and are not engaged in competitive sports. Approximately 15% of the enquirers were users of anabolic androgenic steroids (AAS) or other substances banned within elite sports by the World Anti Doping Agency, and an additional 15% considered using such substances. The present results suggest that there is a pronounced interest in the use of AAS and other PIEDs among Danish gym members.
Collapse
Affiliation(s)
- J Bojsen-Møller
- Institute of Sports Medicine Copenhagen, Faculty of Health Sciences, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | | |
Collapse
|
14
|
|
15
|
Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, Kälebo P, Christiansen AV, Hantel S, Hettiarachchi R, Schnee J, Büller HR. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007; 5:2178-85. [PMID: 17764540 DOI: 10.1111/j.1538-7836.2007.02748.x] [Citation(s) in RCA: 657] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral anticoagulants, such as dabigatran etexilate, an oral, direct thrombin inhibitor, that do not require monitoring or dose adjustment offer potential for prophylaxis against venous thromboembolism (VTE) after total knee replacement surgery. METHODS In this randomized, double-blind study, 2076 patients undergoing total knee replacement received dabigatran etexilate, 150 mg or 220 mg once-daily, starting with a half-dose 1-4 hours after surgery, or subcutaneous enoxaparin 40 mg once-daily, starting the evening before surgery, for 6-10 days. Patients were followed-up for 3 months. The primary efficacy outcome was a composite of total VTE (venographic or symptomatic) and mortality during treatment, and the primary safety outcome was the incidence of bleeding events. RESULTS The primary efficacy outcome occurred in 37.7% (193 of 512) of the enoxaparin group versus 36.4% (183 of 503) of the dabigatran etexilate 220 mg group (absolute difference, -1.3%; 95% CI, -7.3 to 4.6) and 40.5% (213 of 526) of the 150 mg group (2.8%; 95% CI, -3.1 to 8.7). Both doses were noninferior to enoxaparin based on the pre-specified noninferiority criterion. The incidence of major bleeding did not differ significantly between the three groups (1.3% versus 1.5% and 1.3% respectively). No significant differences in the incidences of liver enzyme elevation and acute coronary events were observed during treatment or follow-up. CONCLUSIONS Dabigatran etexilate (220 mg or 150 mg) was at least as effective and with a similar safety profile as enoxaparin for prevention of VTE after total knee-replacement surgery.
Collapse
Affiliation(s)
- B I Eriksson
- Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, Kälebo P, Christiansen AV, Hantel S, Hettiarachchi R, Schnee J, Büller HR. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007. [PMID: 17764540 DOI: 10.3410/f.1098385.554441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Oral anticoagulants, such as dabigatran etexilate, an oral, direct thrombin inhibitor, that do not require monitoring or dose adjustment offer potential for prophylaxis against venous thromboembolism (VTE) after total knee replacement surgery. METHODS In this randomized, double-blind study, 2076 patients undergoing total knee replacement received dabigatran etexilate, 150 mg or 220 mg once-daily, starting with a half-dose 1-4 hours after surgery, or subcutaneous enoxaparin 40 mg once-daily, starting the evening before surgery, for 6-10 days. Patients were followed-up for 3 months. The primary efficacy outcome was a composite of total VTE (venographic or symptomatic) and mortality during treatment, and the primary safety outcome was the incidence of bleeding events. RESULTS The primary efficacy outcome occurred in 37.7% (193 of 512) of the enoxaparin group versus 36.4% (183 of 503) of the dabigatran etexilate 220 mg group (absolute difference, -1.3%; 95% CI, -7.3 to 4.6) and 40.5% (213 of 526) of the 150 mg group (2.8%; 95% CI, -3.1 to 8.7). Both doses were noninferior to enoxaparin based on the pre-specified noninferiority criterion. The incidence of major bleeding did not differ significantly between the three groups (1.3% versus 1.5% and 1.3% respectively). No significant differences in the incidences of liver enzyme elevation and acute coronary events were observed during treatment or follow-up. CONCLUSIONS Dabigatran etexilate (220 mg or 150 mg) was at least as effective and with a similar safety profile as enoxaparin for prevention of VTE after total knee-replacement surgery.
Collapse
Affiliation(s)
- B I Eriksson
- Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Christiansen AV, Paalum H, Andersen SM, Pujadas A, Smitt UW. Quantitative determination of thapsigargins in roots and fruits from Thapsia gymnesica. Planta Med 1997; 63:565-7. [PMID: 17252379 DOI: 10.1055/s-2006-957769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Three sesquiterpene lactones, thapsigargin, thapsigargicin, and nortrilobolid, and 6-methoxy-7-geranyloxycoumarin have been isolated from the roots of Thapsia gymnesica (Apiaceae) for the first time. The concentrations of the three thapsigargins in the roots and the fruits have been determined by HPLC analysis.
Collapse
|