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Johansson, Lars
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Publications (10 of 20) Show all publications
Johansson, M., Johansson, L., Wennberg, M. & Lind, M. (2019). Alcohol Consumption and Risk of First-Time Venous Thromboembolism in Men and Women. Thrombosis and Haemostasis, 119(6), 962-970
Open this publication in new window or tab >>Alcohol Consumption and Risk of First-Time Venous Thromboembolism in Men and Women
2019 (English)In: Thrombosis and Haemostasis, ISSN 0340-6245, Vol. 119, no 6, p. 962-970Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The relationship between alcohol intake and risk of venous thromboembolism (VTE) is unclear. Men and women differ in their drinking habits, which may affect a possible association.

OBJECTIVE: This article investigates the association between alcohol consumption, alcohol dependence and VTE in the total population as well as in men and women separately.

METHODS: We performed a prospective, population-based cohort study in northern Sweden. Study participants were 108,025 (51% women) persons aged 30 to 60 years who underwent a health examination between 1985 and 2014. We assessed alcohol consumption and defined alcohol dependence using a questionnaire. The outcome was a validated first-time VTE.

RESULTS: The mean follow-up time was 13.9 years, and 2,054 participants had a first-time VTE. The mean alcohol consumption was 3.5 standard drinks weekly in men and 1.5 in women. Alcohol dependence was found in 10% of men and 3% of women. There was an association between alcohol consumption (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.03 per standard drink weekly) as well as alcohol dependence (HR, 1.27; 95% CI, 1.06-1.52) and VTE after adjustments. In men, the risk of VTE increased over quartiles of weekly alcohol consumption (p for trend 0.02), with a HR of 1.22 (95% CI, 1.01-1.47) for the highest quartile. Alcohol dependence was associated with VTE in men (HR, 1.30; 95% CI, 1.07-1.59). In women, there were no significant associations.

CONCLUSION: High alcohol consumption and alcohol dependence were associated with increased risk of first-time VTE in men, but not in women.

Place, publisher, year, edition, pages
Georg Thieme Verlag KG, 2019
Keywords
venous thromboembolism, venous thrombosis, alcohol consumption, alcohol intake, alcohol drinking, alcohol dependence, risk marker, prospective studies, cohort studies
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-157495 (URN)10.1055/s-0039-1681100 (DOI)000474924300013 ()30900224 (PubMedID)2-s2.0-85066132287 (Scopus ID)
Projects
Venous thromboEmbolism In Northern Sweden
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and WelfareVästerbotten County Council
Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-09-09Bibliographically approved
Johansson, M., Johansson, L., Wennberg, P. & Lind, M. (2019). Physical activity and risk of first-time venous thromboembolism. European Journal of Preventive Cardiology, 26(11), 1181-1187
Open this publication in new window or tab >>Physical activity and risk of first-time venous thromboembolism
2019 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, no 11, p. 1181-1187Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity may have a protective effect against venous thromboembolism (VTE). The aim of this study was to investigate the association between leisure time physical activity, occupational physical activity, and the risk of VTE in men and women separately.

Methods: The population-based, prospective Venous thromboEmbolism In Northern Sweden (VEINS) cohort study included 108,025 participants of health examinations between 1985 and 2014. Physical activity data were collected by questionnaire. Participants were followed from health examination to first-time VTE event, death, emigration or the end of the study. All VTE events were validated by reviewing medical records and radiology reports.

Results: During 1,496,669 person-years, 2054 participants experienced VTE. Women who performed leisure time physical activity at least once a week had a lower risk of first-time VTE (hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.71–0.98 after adjustments) compared with women with less or no physical activity. Furthermore, women with high occupational physical activity also had a lower risk of VTE (HR 0.85; 95% CI 0.74–0.98). In men, there was no consistent association between either measure of physical activity and the risk of VTE.

Conclusion: We found an association between increased physical activity and a lower risk of first-time VTE in women.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Venous thromboembolism, exercise, physical activity, venous thrombosis
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-156241 (URN)10.1177/2047487319829310 (DOI)000472573700010 ()30727768 (PubMedID)2-s2.0-85061651499 (Scopus ID)
Funder
Västerbotten County Council
Available from: 2019-03-01 Created: 2019-03-01 Last updated: 2019-08-20Bibliographically approved
Johansson, K., Jansson, J.-H., Johansson, L., Wiklund, P.-G., Nilsson, T. K. & Lind, M. (2018). D-Dimer is associated with first-ever intracerebral hemorrhage: a nested case-control study. Stroke, 49(9), 2034-2039
Open this publication in new window or tab >>D-Dimer is associated with first-ever intracerebral hemorrhage: a nested case-control study
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2018 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 49, no 9, p. 2034-2039Article in journal (Refereed) Published
Abstract [en]

Background and Purpose - Hypertension is the most important risk factor for intracerebral hemorrhage (ICH), but further characterization is needed for groups at high risk of ICH. One way to predict the risk of developing a disease is with plasma biomarkers. This study aimed to investigate the association between the biomarker, D-dimer, and ICH risk.

Methods - This population-based, nested case-control study was conducted using data from 2 population-based surveys; the Vasterbotten Intervention Programme and MONICA Northern Sweden (Monitoring Trends and Determinants in Cardiovascular Disease). All participants underwent a health examination and blood sampling at baseline before the event. Cases (n=141) were diagnosed with a first-ever ICH between 1985 and March 2007. One or 2 controls (n=255) were matched to each case.

Results - The median age was 60 years; 39% of participants were women; and the median time from blood sampling to ICH was 5.2 years. When D-dimer was evaluated as a continuous variable, it was significantly associated with ICH. After multivariable adjustment (for hypertension, body mass index, cholesterol levels, diabetes mellitus, and smoking), the odds ratio was 1.36 per SD of D-dimcr (95% CI, 1.05-1.77). When participants were stratified in 3 groups according to time from blood sampling at health examination to ICH, we found that the association between D-dimer levels and ICH was most pronounced in individuals with the shortest time from blood sampling to ICH event (<3.5 years; odds ratio, 1.78; 95% CI, 1.05-3.05).

Conclusions - High plasma concentrations of D-dimer were associated with increased risk of a future ICH, after adjusting for cardiovascular risk factors. This association was predominantly driven by the cases with the shortest time from blood sampling to ICH event.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
biomarkers, case-control studies, cerebral hemorrhage, fibrin fragment, fibrinolysis
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-153829 (URN)10.1161/STROKEAHA.118.021751 (DOI)000442858100014 ()30354971 (PubMedID)
Funder
Västerbotten County CouncilNorrbotten County Council
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-08-20Bibliographically approved
Johansson, K., Jansson, J.-H., Johansson, L., Bylesjö, I., Nilsson, T. K., Eliasson, M., . . . Lind, M. (2017). Factor XII as a Risk Marker for Hemorrhagic Stroke: A Prospective Cohort Study. Cerebrovascular diseases extra, 7(1), 84-94
Open this publication in new window or tab >>Factor XII as a Risk Marker for Hemorrhagic Stroke: A Prospective Cohort Study
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2017 (English)In: Cerebrovascular diseases extra, ISSN 1664-5456, Vol. 7, no 1, p. 84-94Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Coagulation factor XII (FXII) is involved in pathological thrombus formation and is a suggested target of anticoagulants. It is unclear whether FXII levels are correlated with cardiovascular risk factors and whether they are associated with myocardial infarction or ischemic or hemorrhagic stroke. The aim of this study was to investigate the correlation between FXII and cardiovascular risk factors in the general population. We also aimed to study the associations between FXII levels and future myocardial infarction and ischemic and hemorrhagic stroke.

METHODS: This prospective cohort study measured FXII levels in 1,852 randomly selected participants in a health survey performed in northern Sweden in 1994. Participants were followed until myocardial infarction, stroke, death, or until December 31, 2011.

RESULTS: During the median follow-up of 17.9 years, 165 individuals were diagnosed with myocardial infarction, 108 with ischemic stroke, and 30 with hemorrhagic stroke. There were weak correlations between FXII and body mass index, cholesterol, and hypertension. There was no association between FXII and myocardial infarction or ischemic stroke, neither in univariable Cox regression analysis nor after adjustment for age, sex, smoking, body mass index, cholesterol, hypertension, and diabetes. In univariable Cox regression analysis, the hazard ratio for the association between FXII levels and hemorrhagic stroke was 1.42 per SD (95% confidence interval: 0.99-2.05). In the multivariable model, higher levels of FXII were associated with increased risk of hemorrhagic stroke (hazard ratio 1.51 per SD; 95% confidence interval: 1.03-2.21).

CONCLUSION: We found an independent association between FXII levels and the risk of hemorrhagic stroke, but not between FXII levels and ischemic stroke or myocardial infarction.

Place, publisher, year, edition, pages
S. Karger, 2017
Keywords
Coagulation, Biomarkers, Intracranial hemorrhage, Cohort study, Cardiovascular disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-136401 (URN)10.1159/000468994 (DOI)000405098500004 ()28433996 (PubMedID)
Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2019-08-20Bibliographically approved
Johansson, C., Hägg, L., Johansson, L. & Jansson, J.-H. (2014). Characterization of patients with atrial fibrillation not treated with oral anticoagulants. Scandinavian Journal of Primary Health Care, 32(4), 226-231
Open this publication in new window or tab >>Characterization of patients with atrial fibrillation not treated with oral anticoagulants
2014 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 4, p. 226-231Article in journal (Refereed) Published
Abstract [en]

Objective: An underuse of oral anticoagulants (OAC) in patients with atrial fibrillation (AF) has been suggested, as only 50% of all patients with AF receive OAC treatment. Whether this is due to contraindications, lack of an indication to treat, or an expression of underuse is sparsely investigated. This study therefore aimed to characterize individuals without OAC treatment in a real-life population of patients with AF. Design: Retrospective cross-sectional study. The medical records were scrutinized in order to identify the type of AF, risk factors for embolism and bleeding, and other factors of importance for OAC treatment. Setting: The municipalities of Skellefteå and Norsjö, northern Sweden. Subjects: A total of 2274 living residents with at least one verified episode of AF on or before December 31, 2010. Main outcome measures: Prevalence of treatment with OAC and documented reasons to withhold OAC treatment. Results: Among all 2274 patients with AF, 1187 (52%) were not treated with OAC. Of the untreated patients, 19% had no indication or had declined or had experienced adverse effects other than bleeding on warfarin treatment. The most common reason to withhold OAC was presence of risk factors for bleeding, found in 38% of all untreated patients. Furthermore, a documented reason could be identified to withhold OAC in 75%. Conclusions: Among patients with AF without OAC treatment a reason could be identifi ed to withhold OAC in 75%. The underuse of OAC is estimated to be 25%.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
Keywords
Atrial fibrillation, anticoagulation, epidemiology, general practice, risk factors, thromboembolic risk, romboembolism, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-97885 (URN)10.3109/02813432.2014.984952 (DOI)000346108700012 ()
Available from: 2015-01-15 Created: 2015-01-08 Last updated: 2018-06-07Bibliographically approved
Johansson, M., Johansson, L. & Lind, M. (2014). Incidence of venous thromboembolism in northern Sweden (VEINS): a population-based study. Thrombosis Journal, 12, Article ID 6.
Open this publication in new window or tab >>Incidence of venous thromboembolism in northern Sweden (VEINS): a population-based study
2014 (English)In: Thrombosis Journal, ISSN 1477-9560, E-ISSN 1477-9560, Vol. 12, article id 6Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The reported incidence of venous thromboembolism (VTE) varies considerably among studies. The primary aim of this study was to describe the incidence of VTE in relation to age and sex. The secondary aim was to describe the risk factor pattern at the time of diagnosis.

METHODS: This retrospective, population-based cohort study included all adult residents in the County of Västerbotten in northern Sweden during the year 2006 (n = 204,836). All potential VTE events were manually validated and classified according to location. The presence of risk factors for VTE at the time of diagnosis was recorded.

RESULTS: We identified 517 adult individuals with potential VTE. Among these, 343 individuals (158 men and 185 women) had a verified VTE event in 2006. The mean incidence was 167 individuals per 100,000 person years; 155 for men and 180 for women. The mean age at diagnosis was 67.6 years in men and 72.5 years in women. The incidence of VTE increased with age. The incidence was highest in women aged 85 years or more. Pulmonary embolism with or without concurrent deep vein thrombosis was diagnosed in 161 individuals (46.9%); lower extremity deep vein thrombosis without concurrent pulmonary embolism was diagnosed in 157 individuals (45.8%); and VTE in another location was diagnosed in 25 individuals (7.3%). The most common risk factors for VTE were recent hospitalization and concurrent malignancy.

CONCLUSION: The incidence of VTE was 167 per 100,000 person years and increased with age. The incidence was highest among older women. Pulmonary embolism was the most common form of VTE; it affected 47% of individuals with VTE. Malignancy and hospitalization were the most prevalent risk factors for VTE.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Venous thromboembolism, Venous thrombosis, Pulmonary embolism, Deep vein thrombosis, Risk factors, Incidence, Epidemiology, Adults
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-120815 (URN)10.1186/1477-9560-12-6 (DOI)24593768 (PubMedID)
Available from: 2016-05-23 Created: 2016-05-23 Last updated: 2019-08-20Bibliographically approved
Lind, M., Jansson, J.-H., Nilsson, T. K., Järvholm, L. S. & Johansson, L. (2013). Cystatin C and creatinine as markers of bleeding complications, cardiovascular events and mortality during oral anticoagulant treatment. Thrombosis Research, 132(2), E77-E82
Open this publication in new window or tab >>Cystatin C and creatinine as markers of bleeding complications, cardiovascular events and mortality during oral anticoagulant treatment
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2013 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 132, no 2, p. E77-E82Article in journal (Refereed) Published
Abstract [en]

Introduction: Impaired kidney function has been linked to both ischemic events as well as bleeding complications in several clinical conditions. Our aim was to investigate if cystatin C, creatinine and calculated glomerular filtration rate (eGFR) were related to future risk of bleeding complications, cardiovascular events or all-cause mortality during oral anticoagulant treatment.

Materials and methods: In a cohort study, 719 patients on long-term vitamin K antagonist (VKA) treatment were followed for a mean of 4.2 years. Blood sampling was taken at inclusion and patients were followed prospectively. Cystatin C and creatinine were analysed and eGFR was calculated. All medical records were reviewed. Major bleeding events, myocardial infarctions, strokes, arterial emboli, and deaths were recorded and classified.

Results: After adjustment for age, no association between cystatin C, creatinine or eGFR and major bleeding was found. Cystatin C was independently associated with cardiovascular events (hazard ratio 1.50 (95% CI: 1.27-1.77)) and all-cause mortality (hazard ratio 1.62 (95% CI: 1.38-1.90)). Creatinine was only associated with all-cause mortality, while eGFR was not associated with any of the outcomes.

Conclusions: Our findings underscore the superiority of cystatin C as a marker of cardiovascular risk compared to creatinine or eGFR. VKA-treated patients with increased cystatin C levels should be considered to be at an increased risk of cardiovascular events, and not bleeding complications.

Place, publisher, year, edition, pages
Pergamon-Elsevier, 2013
Keywords
Anticoagulation, Cystatin C, Kidney function, Bleeding, Mortality
National Category
Hematology
Identifiers
urn:nbn:se:umu:diva-81324 (URN)10.1016/j.thromres.2013.06.011 (DOI)000324059600001 ()
Available from: 2013-10-11 Created: 2013-10-07 Last updated: 2019-08-20Bibliographically approved
Norberg, J., Bäckström, S., Jansson, J.-H. & Johansson, L. (2013). Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clinical Epidemiology, 5(1), 475-481
Open this publication in new window or tab >>Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data
2013 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 5, no 1, p. 475-481Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The purpose of this study was to determine the prevalence of atrial fibrillation (AF) in the general population and to validate an administrative diagnosis register, ie, the National Patient Register (NPR), and an electrocardiography (ECG) database in estimating disease prevalence.

METHODS: The study was conducted in a well defined region in northern Sweden (population n=75,945) which consists of one hospital and eleven primary health care centers. Subjects with AF were identified by searching the combined inpatient and outpatient International Classification of Diseases (ICD)-based NPR (ICD-10 code I48) and an ECG database with computer-interpreted AF from January 1, 2004 to December 31, 2010. All identified cases with AF were validated.

RESULTS: AF was confirmed in 2,274 patients. The overall prevalence was 3.0% (3.4% in men and 2.6% in women). AF prevalence rose steadily with age, and was 16.8% in patients aged 75 years and older and 21.9% in patients 85 years and older. Of all patients with validated AF, the NPR identified 93.2%. The ECG database identified an additional 6.8%, of which 81% were over 70 years of age. According to the NPR, the proportion of false positives and false negatives was 3.5% and 6.8%, respectively. The corresponding figure for the ECG database was 11.3% and 9.2%, respectively.

CONCLUSION: Our study shows a high prevalence of AF, especially among the elderly. Searching the ECG database enhanced the detection of AF. The reliability of the NPR was high, with a relatively low proportion of false positives and negatives.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-120686 (URN)10.2147/CLEP.S53420 (DOI)24353441 (PubMedID)
Available from: 2016-05-18 Created: 2016-05-18 Last updated: 2018-06-07Bibliographically approved
Wennberg, P., Wensley, F., Di Angeloantonio, E., Johansson, L., Boman, K., Rumley, A., . . . Jansson, J.-H. (2012). Haemostatic and inflammatory markers are independently associated with a first-ever myocardial infarction in men and women. Thrombosis Research, 129(1), 68-73
Open this publication in new window or tab >>Haemostatic and inflammatory markers are independently associated with a first-ever myocardial infarction in men and women
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2012 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 129, no 1, p. 68-73Article in journal (Refereed) Published
Abstract [en]

Introduction: Previous studies have shown that plasma levels of haemostatic and inflammatory markers are associated with risk of coronary heart disease (CHD). As haemostatic markers are also acute-phase reactants, it is not clear if their association with CHD is independent of inflammatory markers and established cardiovascular risk factors.

Materials and Methods: We used a prospective incident case-control study design nested in two cohorts from Sweden. Baseline measurements of a panel of cardiovascular risk factors and eight established markers of haemostasis or inflammation were assessed in 469 first-ever myocardial infarction (MI) cases and 895 matched controls.

Results: After adjustment for baseline values of established risk factors, von Willebrand factor appeared to have the strongest association with MI among the haemostatic markers assayed, with an odds ratio of 2.52 (95% CI, 1.72-3.67) for a comparison of individuals in extreme thirds of baseline levels. For a similar comparison, after adjustment for established risk factors and haemostatic markers, odds ratios for IL-6 and CRP were 1.67 (95% CI, 1.08-2.60) and 1.58 (95% CI, 1.03-2.41), respectively. The relative predictive ability of the individual markers over and above established risk factors was modest according to comparisons of Area under the Receiver Operating Characteristic (AUROC) curves. However, when all eight markers were combined in a single model, the AUROC curve was significantly increased to 0.820 (95% CI, 0.795-0.846) compared to 0.762 (95% CI, 0.732-0.791) for established risk factors only.

Conclusions: These findings suggest that haemostasis and inflammation have at least partially separate roles in risk of myocardial infarction.

Keywords
Myocardial infarction; Risk factors; Haemostasis; Inflammation
National Category
Cardiac and Cardiovascular Systems
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-21694 (URN)10.1016/j.thromres.2011.05.015 (DOI)
Available from: 2009-04-16 Created: 2009-04-16 Last updated: 2018-08-31Bibliographically approved
Wennberg, P., Wensley, F., Di Angelantonio, E., Johansson, L. A., Boman, K., Rumley, A., . . . Jansson, J.-H. (2012). Haemostatic and inflammatory markers are independently associated with myocardial infarction in men and women. Thrombosis Research, 129(1), 68-73
Open this publication in new window or tab >>Haemostatic and inflammatory markers are independently associated with myocardial infarction in men and women
Show others...
2012 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 129, no 1, p. 68-73Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Previous studies have shown that plasma levels of haemostatic and inflammatory markers are associated with risk of coronary heart disease (CHD). As haemostatic markers are also acute-phase reactants, it is not clear if their association with CHD is independent of inflammatory markers and established cardiovascular risk factors.

MATERIALS AND METHODS: We used a prospective incident case-control study design nested in two cohorts from Sweden. Baseline measurements of a panel of cardiovascular risk factors and eight established markers of haemostasis or inflammation were assessed in 469 first-ever myocardial infarction (MI) cases and 895 matched controls.

RESULTS: After adjustment for baseline values of established risk factors, von Willebrand factor appeared to have the strongest association with MI among the haemostatic markers assayed, with an odds ratio of 2.52 (95% CI, 1.72-3.67) for a comparison of individuals in extreme thirds of baseline levels. For a similar comparison, after adjustment for established risk factors and haemostatic markers, odds ratios for IL-6 and CRP were 1.67 (95% CI, 1.08-2.60) and 1.58 (95% CI, 1.03-2.41), respectively. The relative predictive ability of the individual markers over and above established risk factors was modest according to comparisons of Area under the Receiver Operating Characteristic (AUROC) curves. However, when all eight markers were combined in a single model, the AUROC curve was significantly increased to 0.820 (95% CI, 0.795-0.846) compared to 0.762 (95% CI, 0.732-0.791) for established risk factors only.

CONCLUSIONS: These findings suggest that haemostasis and inflammation have at least partially separate roles in risk of myocardial infarction.

Keywords
Myocardial infarction; Risk factors; Haemostasis; Inflammation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-53510 (URN)10.1016/j.thromres.2011.05.015 (DOI)21641633 (PubMedID)
Available from: 2012-03-29 Created: 2012-03-29 Last updated: 2018-08-31Bibliographically approved
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