loading dose of 600 mg on day 1, followed by 150 mg once daily on days 2 through 7. Administration of high doses of clopidogrel and aspirin can achieve accelerated platelet inhibition in the acute setting. Clopidogrel oral tablet is a prescription medication used to prevent heart attack or stroke. Offer aspirin 300 mg immediately unless contraindicated — give a proton-pump inhibitor to anyone with dyspepsia associated with aspirin use. – Initiate Plavix with a single 300 mg oral loading dose and then continue at 75 mg once daily. In patients who need an antiplatelet effect within hours, initiate clopidogrel tablets with a single 300 mg oral loading dose and then continue at 75 mg once daily. We compared outcomes in patients with baseline NIHSS > 3 with and without clopidogrel loading. Initiating clopidogrel tablets without a loading dose will delay establishment of an antiplatelet effect by several days [see Clinical Pharmacology (12.3) and Clinical Studies (14.1)]. The LOAD group was defined as patients who were administered a loading dose of 300 mg or more of clopidogrel with or without aspirin within 24 hours of admission. High risk patients: multiple events in more than one vascular territory, e.g. • A 10- to 21-day course of dual antiplatelet therapy reduces stroke recurrence and improves quality of life after mild stroke or high-risk TIA. Concomitant administration of clopidogrel and repaglinide increased the systemic exposure of repaglinide 5.1-fold after a clopidogrel 300 mg loading dose and 3.9-fold on day 3 of clopidogrel 75 mg/day. Results. Patients were randomized to receive clopidogrel (300 mg loading dose followed by 75 mg once daily) or placebo, and were treated for up to one year. Initiating clopidogrel tablets without a loading dose will delay … The 300-mg loading dose for ACS patients is already FDA approved, but must be administered as four 75 … Generally, clopidogrel should be given as a single daily dose of 75 mg. Initiating clopidogrel without a loading dose will delay establishment of an antiplatelet effect by several days [see Clinical Pharmacology ( 12.3 ) and Clinical Studies ( 14.1 )] . Plavix can be administered with or without food [see Clinical Pharmacology (12.3)] • For patients with non-ST-elevation ACS (UA/NSTEMI), initiate Plavix with a single 300 mg oral loading dose and then continue at 75 mg once daily. Clopidogrel is currently available as 75-mg tablets for chronic use. Clopidogrel should be given as a single daily dose of 75 mg. This 300 mg tablet of clopidogrel is intended for use as a loading dose. In patients suffering from acute coronary syndrome: Ticagrelor vs. Clopidogrel in Stroke or TIA A mong patients with an acute mi- ... a 300-mg loading dose of clopidogrel on day 1, followed by 75 mg daily on days 2 through 90. – Initiating Plavix without a loading dose will delay establishment of an anti-platelet effect by several days. Initiating Plavix without a loading dose will delay establishment of an antiplatelet effect by several days. Dosage/Direction for Use. Background: The optimal loading dose of clopidogrel in one-stop hybrid coronary revascularization (HCR) remains an "evidence-free" zone. Patients also received ASA (150 to 325 … To reduce thrombotic cardiovascular events, including stent thrombosis in patients with ACS who are to be managed with percutaneous coronary intervention (PCI) Dosing recommendation . Aspirin was initiated with 75-300 mg loading dose followed by 75 mg daily for 21 days. To reduce the rate of myocardial infarction and stroke in patients with ACS. The patients were randomly assigned to receive the following in a 2 x 2 factorial design: (1) clopidogrel, 600 mg, vs 300-mg loading dose and (2) atorvastatin reload with 80 … In 2 large randomized controlled trials, initiation of aspirin within 48 hours of stroke onset was beneficial for prevention of acute ischemic stroke (AIS) recurrence with a dose of aspirin 300 … rate of MI and stroke. 1,2 In patients undergoing percutaneous coronary intervention (PCI), the best time to administer clopidogrel is at least 6 or more hours prior to the procedure … Short-term bleeding events observed with clopidogrel loading in acute ischemic stroke patients Lester Y. Leung, Karen C. Albright, Amelia K. Boehme, Joseph Tarsia, Kamal R. Shah, James … These studies also showed faster onset of action of 600 mg clopidogrel as compared with 300 mg loading dose [16- 20]. In the chronic therapy group, loading with 600 mg clopidogrel yielded further inhibition of ADP 5 μmol/L–induced platelet aggregation in addition to that achieved by the maintenance dose of 75 mg/d, from 52±14% to 33±12% (P<0.001). In this trial, 13,608 patients with moderate and high-risk ACS were randomized to prasugrel (60 mg loading dose and 10 mg daily maintenance dose) or clopidogrel (300 mg loading dose and 75 mg daily maintenance dose) for 6–15 months (median 14.5 months). In ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention, administration of a 600-mg LD of clopidogrel is associated with a lower risk of MACE than is administration of a 300-mg LD, … Clopidogrel tablets have been shown to reduce the combined endpoint of new ischemic stroke, new MI, and other vascular death. A 300-mg clopidogrel loading dose followed by 75 mg daily in addition to aspirin has also proven beneficial over aspirin alone in patients with acute myocardial infarction (MI) … wave MI), PLAVIX should be initiated with a 300 mg loading dose and continued long term at 75 mg once a day with ASA (80 mg-325 mg daily) (see CLINICAL TRIALS). Previous trials have suggested that a 300 mg loading dose decreases the time to maximal platelet inhibition (as measured by ex vivo platelet aggregation studies) with clopidogrel as compared to lower doses. They had a loading dose (LD) of 300–600 mg, or ticagrelor 180 mg LD followed by 90 mg twice daily. Typical starting dosage: 300 mg, taken one time. Patients were randomized to receive clopidogrel (300-mg loading dose followed by 75 mg once daily) or placebo, and were treated for up to one year. Objective: To assess outcome, safety and possible mechanism of loading dose clopidogrel in patients with transient ischemic attack (TIA) and minor stroke. -Loading dose: 300 mg orally once Ischemic Stroke Plavix, aspirin, clopidogrel. In this multicenter, double-blind, randomized trial, we compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to … To reduce thrombotic cardiovascular events, including stent thrombosis in patients with ACS who … We compared outcomes in patients with baseline NIHSS > 3 with and without clopidogrel loading. • Recent MI, recent stroke, or established peripheral arterial disease: 75 mg once daily orally without a loading dose. Acute Coronary Syndrome: In patients who need an antiplatelet effect within hours, initiate clopidogrel with a single 300 mg (4 tablets) oral loading dose and then continue at 75 mg … Clopidogrel is used to lower your risk of having a stroke, blood clot, or serious heart problem after you've had a heart attack, severe chest pain , or circulation problems. Differences in than a 300 mg loading dose. If the patient is older than 75 years, then the loading dose is omitted. PCI during ACS/non-ACS setting: Administer a 600 mg loading dose as early as possible before PCI, followed by 75 mg daily. Ideally, clopidogrel should be administered with aspirin for at least 12 months post-ACS. Ticagrelor was superior to clopidogrel in ACS patients regarding death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding [ 4 ]. All will be followed for 1 year. Rifampin: Coadministration of rifampin 300 mg twice daily for 7 days with 600 mg loading dose of clopidogrel in healthy adults increased the mean AUC and C max of … Loss-of-function allele carriers of CYP2C19 … In most studies of clopidogrel, a 300-mg loading dose is used more than 6 hours before PCI, to ensure that this inactive prodrug has time to form sufficient amounts of active … daily on days 2–90) or clopidogrel (300 mg loading dose on day 1 followed by 75 mg daily on days 2–90), plus open- label aspirin with a dose of 75–300 mg on day 1 followed by 75 mg daily on day 2–21. •Clopidogrel (300–600 mg loading dose, 75 mg … Adult & elderly Non-ST segment elevation acute coronary syndrome (unstable angina or non-Q wave MI) Initially 300 mg as single loading dose, then continued at … To update your cookie settings, please visit the Cookie Preference Center for this site. attack to clopidogrel-aspirin therapy (loading dose of 300 mg of clopidogrel on day 1, followed by 75 mg of clopidogrel per day for 90 days, plus 75 mg of aspirin per day for the first 21 days) or to the aspirin-alone group (75 mg/d for 90 days). Clopidogrel is used to prevent heart attacks and strokes in persons with heart disease (recent heart attack), recent stroke, or blood circulation disease (peripheral vascular … We randomly assigned 5170 patients within 24 hours after onset of minor stroke or high-risk transient ischemic attack to clopidogrel-aspirin therapy (loading dose of 300 mg of clopidogrel on day 1, followed by 75 mg of clopidogrel per day for 90 days, plus 75 mg of aspirin per day for the first 21 days) or to the aspirin-alone group (75 mg/d for 90 days). -Loading dose: 300 mg orally once (OPTIONAL)-Maintenance dose: 75 mg orally once a day, with or without thrombolytics-Duration of therapy: Optimal duration unknown. To reduce the rate of myocardial infarction and stroke in patients with ACS. 12 The smaller loading dose or limited duration … STEMI patients receiving fibrinolytic therapy: If the patient’s age is 75 years or younger, then give a 300 mg loading dose followed by 75 mg daily for at least 14 days and up to 1 year. - ST segment elevation acute myocardial infarction: clopidogrel should be given as a single daily dose of 75 mg initiated with a 300 mg loading dose in combination with ASA and with or without thrombolytics. 2 DOSAGE AND ADMINISTRATION . Methods: We reviewed patients with confirmed TIA and minor stroke admitted between July 2016 and December 2017 into the First Affiliated Hospital of Soochow University. Ticagrelor (180 mg loading dose) was dosed at 90 mg twice daily, while clopidogrel (300 mg loading dose) was dosed at 75 mg daily. Within 24 hours of their symptom onset, they were randomly assigned to 1 of 2 groups: aspirin (1 day loading dose of … The 300-mg loading dose for ACS patients is already FDA approved but must be administered as four 75 … Ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300 mg loading dose, 75 mg daily thereafter) on a background of aspirin (100 mg daily for the first 21 days) … The recommended loading dose of clopidogrel for patients with PCI is currently 300 mg. Combination of OAC + clopidogrel 75 mg/day or dual antiplatelet therapy consisting of aspirin 75-mg/day and clopidogrel 75 mg/day may be However, it has a number of drawbacks, including an increased risk of hemorrhage; a clinical effect that is slow in onset and irreversible; a genetically determined variability in its clinical potency; and interactions with other commonly administered drugs. Initiating clopidogrel tablets without a loading dose will delay establishment of an antiplatelet effect by several days [see Clinical Pharmacology (12.3) and Clinical Studies (14.1)]. Advise people already taking low dose aspirin regularly to continue — do not offer them aspirin 300 mg. In patients with acute coronary syndrome: • unstable angina or non-ST elevation myocardial infarction – clopidogrel treatment should be initiated with a single 300 mg loading dose and then continued long-term at 75 mg once a day planned for thrombolytic therapy. The primary outcome was stroke event (ischemic or hemorrhagic) during 1-year follow-up. Patients also received aspirin (75 to 325 mg once daily) and other standard therapies such as heparin. In the chronic therapy group, loading with 600 mg clopidogrel yielded further inhibition of ADP 5 μmol/L–induced platelet aggregation in addition to that achieved by the … In patients who need an antiplatelet effect within hours, initiate clopidogrel tablets with a single 300 mg oral loading dose and then continue at 75 mg once daily. Recent studies have suggested that 600 mg may decrease periprocedural complications in patients … The Antiplatelet therapy for … Ticagrelor (rather than clopidogrel) is chosen for a minority …. Clopidogrel is an inhibitor of platelet aggregation, indicated for the prevention of ischemic stroke and in-stent thrombosis. Acute ischemic stroke patients presenting consecutively to our center from 07/01/08 to 07/31/13 were screened. In patients who need an antiplatelet effect within hours, initiate clopidogrel tablets with a single 300 mg oral loading dose and then continue at 75 mg once daily. Neither loading dose of clopidogrel has been studied in patients with acute MI undergoing primary PCI. Antithrombotic … The acyl-beta-gluconuride metabolite of clopidogrel is a strong CYP2C8 inhibitor, and repaglinide is primarily metabolized by CYP2C8. Clopidogrel may also be used for purposes not listed in this medication guide. ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspi- rin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, Clopidogrel oral tablet is a prescription drug that’s available as the brand-name drug Plavix.It’s also available as a generic drug. The use of GPIIb/IIIa inhibitors was not permitted for three days prior to randomization. Patients were randomized to receive clopidogrel bisulfate (300 mg loading dose, followed by 75 mg/day) or placebo. For patients with ST … Results. The study compared BRILINTA (180-mg loading dose, 90 mg twice daily thereafter) to clopidogrel (300-mg to 600-mg loading dose, 75 mg daily thereafter) for the prevention of … Ticagrelor vs. Clopidogrel in Stroke or TIA A mong patients with an acute mi- ... a 300-mg loading dose of clopidogrel on day 1, followed by 75 mg daily on days 2 through 90. The risk of recurrent stroke was 7.1% compared with 10.8% in the placebo arm (p=0.019).15 A trial using clopidogrel loading dose at least 300 mg (with or without aspirin) for moderate and … Finally, we recognize that a more pronounced platelet inhibition by antiplatelet drugs may not translate into clinical benefit and that there may be safety concerns relating to increased bleeding with higher doses of clopidogrel. With a loading dose of 300 mg or 600 mg clopidogrel, dabigatran AUC τ,ss and C max,ss were increased by about 30-40% (see section 4.4) . Acute ischemic stroke patients presenting consecutively to our center from 07/01/08 to 07/31/13 were screened. Patients also received aspirin (75 to 325 mg once daily) and other standard therapies such as heparin. If aspirin is contraindicated discuss management urgently with the specialist team. Design CHANCE-2 is a randomised, double-blind, double-dummy, placebo-controlled, multicentre trial that compares two dual antiplatelet strategies for minor stroke or TIA patients who are CYP2C19 LOF allele carriers: ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily on days 2–90) or clopidogrel (300 mg loading dose on day 1 … Inclusion criteria were met for 1011 … Clopidogrel is used to prevent heart attacks and strokes in persons with heart disease (recent heart attack), recent stroke, or blood circulation disease (peripheral vascular disease).. Clopidogrel is also used with aspirin to treat new/worsening chest pain (new heart attack, unstable angina) and to keep blood vessels open and prevent blood clots after certain … To date, diminished antiplatelet responses to clopidogrel have been described for Lower active metabolite exposure results in less platelet inhibition or higher residual platelet reactivity. The use of GPIIb/IIIa inhibitors was not permitted for three days prior to randomization. In patients who need an antiplatelet effect within hours, initiate Plavix with a single 300 mg oral loading dose and then continue at 75 mg once daily. Study outcomes The primary efficacy outcome is any stroke (ischaemic or haemorrhagic) within 3 months and Aspirin or clopidogrel 300mg as a loading dose then 75mg daily2 Combination of aspirin with clopidogrel is not recommended in stroke/TIA as it significantly increases the risk of major bleeding. Loading dose 300 mg, to be taken prior to the procedure, alternatively loading dose 600 mg, higher dose may produce a greater and more rapid inhibition of platelet aggregation. infarction (MI) or recent stroke Plavix is indicated to reduce the rate of MI and stroke. Background: The optimal loading dose of clopidogrel in one-stop hybrid coronary revascularization (HCR) remains an "evidence-free" zone. Patient received prasugrel for ≤5 days: Give a clopidogrel 300 mg loading dose 24 hours after the last dose of prasugrel, followed by 75 mg once daily; some experts do not … The study compared BRILINTA (180-mg loading dose, 90 mg twice daily thereafter) to clopidogrel (300-mg to 600-mg loading dose, 75 mg daily thereafter) for the prevention of … A 300-mg clopidogrel loading dose followed by 75 mg daily in addition to aspirin has also proven beneficial over aspirin alone in patients with acute myocardial infarction (MI) treated with fibrinolytic therapy (15, 16). We use cookies to help provide and enhance our service and tailor content. metabolite by 30-50% following 300- or 600 mg loading doses and 75 mg maintenance doses. MI and stroke : Aspirin and clopidogrel : Aspirin 100 mg daily and clopidogrel 300 mg loading dose followed by 75 … Patients in the latter group received placebo ticagrelor, a 300-mg loading dose of clopidogrel on day one, and 75 mg of clopidogrel daily from days 2 through 90. Initiate clopidogrel tablets with a single 300 mg oral loading dose and then continue at 75 mg once daily. Randomization took place after coronary angiography and before PCI. The lack of comparator control arms with 300-mg loading doses of clopidogrel is another limitation of this study. Initiate aspirin (75-325 mg once daily) and continue in combination with Plavix [see Clinical Studies (14.1)]. Patients were randomized to receive clopidogrel (300 mg loading dose followed by 75 mg once daily) or placebo, and were treated for up to one year. Patients also received aspirin (75 mg to … The use of GPIIb/IIIa inhibitors was not permitted for three days prior to randomization. Clopidogrel is currently available as 75-mg tablets for chronic use. -Loading dose: 300 mg orally once (OPTIONAL)-Maintenance dose: 75 mg orally once a day, with or without thrombolytics-Duration of therapy: Optimal duration unknown. Patients in the ticagrelor group received placebo clopidogrel plus a 180-mg loading dose of ticagrelor on day 1, followed by 90 mg twice daily on days 2 through 90. Outcome comparison of 600 mg versus 300 mg loading dose of clopidogrel for patients with ST-elevation myocardial infarction: a meta-analysis. METHODS: We randomly assigned, in a 2-by-2 factorial design, 25,086 patients with an acute coronary syndrome who were referred for an invasive strategy to either double-dose … Ticagrelor was superior to clopidogrel in ACS patients regarding death … Generic drugs usually cost less than the … Furthermore, in the control arm the loading dose of clopidogrel was either 300 mg or 600 mg and could be given at the beginning or end of PCI, although the EPAR states … Within 24 h of symptom onset, we randomly assigned, in a factorial design, 392 patients with TIA or minor stroke to clopidogrel (300 mg loading dose then 75 mg daily; 198 patients) or … Patients received a standard 300 mg clopidogrel loading dose followed by a 75 mg per day dosage or a 600 mg double clopidogrel loading dose followed by a 150 mg … They had a loading dose (LD) of 300–600 mg, or ticagrelor 180 mg LD followed by 90 mg twice daily. Within 24 h of symptom onset, we randomly assigned, in a factorial design, 392 patients with TIA or minor stroke to clopidogrel (300 mg loading dose then 75 mg daily; 198 patients) or … This study aimed to compare the major bleeding and ischemic thrombotic events between different clopidogrel loading doses (300 vs. 600 mg) in one-stop HCR. (2.2) DAPT given for 21 days only. For medically treated patients over 75 years of age clopidogrel should be initiated without a loading dose. Short Course of Aspirin, Clopidogrel Cuts Stroke Risk. Acute Coronary Syndrome: In patients who need an antiplatelet effect within hours, initiate clopidogrel with a single 300 mg (4 tablets) oral loading dose and then continue at 75 mg … However, it has a number of drawbacks, including an increased risk of hemorrhage; a clinical effect that is slow in onset and irreversible; a genetically determined variability in its clinical potency; and interactions with other commonly administered drugs. The CHANCE trial tested a different combination of clopidogrel and aspirin than was used in our trial (two medications combined for the first 21 days, followed by clopidogrel alone with an initial loading dose of 300 mg, as compared with 600 mg of clopidogrel, followed by 75 mg per day, for the duration of our trial). Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). Patients were randomized to receive clopidogrel bisulfate (300 mg loading dose followed by 75 mg once daily) or placebo, and were treated for up to one year. daily on days 2–90) or clopidogrel (300 mg loading dose on day 1 followed by 75 mg daily on days 2–90), plus open- label aspirin with a dose of 75–300 mg on day 1 … Medical treatment of UA/NSTEMI: Administer a 300 mg to 600 mg loading dose followed by 75 mg daily, in conjunction with aspirin, ideally for up to 12 months. The study compared BRILINTA (180-mg loading dose, 90 mg twice daily thereafter) to clopidogrel (300-mg to 600-mg loading dose, 75 mg daily thereafter) for the prevention of thrombotic CV events (CV death, MI, or stroke). 2.1 Acute Coronary Syndrome . von Beckerath N, Taubert D, Pogatsa-Murray G, Schomig E, Kastrati A, Schomig A. Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of … ... a loading dose of 300 to 600 mg is … This study aimed to compare the … 3 (1.1) Initiate Plavix with a single 300 mg oral loading dose and then continue at 75 mg once daily. • Low-dose aspirin and a … A minimal loading dose of 300 mg Clopidogrel (based on dose in CHANCE) up to 600mg (based on dose used in POINT) and 160 mg of acetylsalicylic acid should be given at the start … Single 300-mg loading dose followed by 75-mg once every day with or without food The dose of clopidogrel is 600 mg, and it should be given at least two hours before the procedure. Primary endpoint: CV death + MI + Stroke Primary safety endpint: Total major bleeding 6–12-month exposure Clopidogrel If pre-treated, no additional loading dose; if … Dose Adults . After 3 months, patients were treated at the discretion of the local investigator and followed for another 9 months. Initiating Plavix without a loading dose will Comparison of 600 versus 300-mg Clopidogrel loading dose in patients with ST-segment elevation … The study population was divided into 2 groups: 126 patients received a 300-mg clopidogrel loading dose, and 319 patients received a 600-mg clopidogrel loading dose at the time of the procedure. Patients also received aspirin (75 mg to 325 mg once daily) and other standard therapies such as heparin. Patients assigned to standard-dose clopidogrel received a 300-mg loading dose on day 1 before … •Prasugrel (60 mg loading dose, 10 mg daily dose) is recommended in patients who are proceeding to PCI if no contraindication. Recent MI, recent stroke, or established peripheral arterial disease: 75 mg once daily orally without a loading dose . - ST segment elevation acute myocardial infarction: clopidogrel should be given as a single daily dose of 75 mg initiated with a 300 mg loading dose in combination with ASA and with or without thrombolytics. For medically treated patients over 75 years of age clopidogrel should be initiated without a loading dose. 7, 8 Loading doses of 300 mg of clopidogrel at least 6 hours before a coronary intervention reduces the risk of recurrent vascular events. Aspirin or clopidogrel 300mg as a loading dose then 75mg daily2 Combination of aspirin with clopidogrel is not recommended in stroke/TIA as it significantly increases the risk of major … As part of the center’s protocol, all patients received a DAPT regimen consisting of a loading dose of aspirin 300 mg and clopidogrel 600 mg the day before the planned … (1.2) -----DOSAGE AND ADMINISTRATION----- Acute … Prevention of atherothrombotic events in percutaneous coronary intervention (adjunct with aspirin) in patients not already on clopidogrel. - Initiate clopidogrel with a single 300 mg oral loading dose and then continue at 75 mg once daily -Initiating clopidogrel without a loading dose will delay establishment of an antiplatelet effect by several days . 5170 patients within 24 h after the onset of minor ischemic stroke or high-risk TIA: Clopidogrel (300 mg load then 75 mg/d) plus aspirin 75 mg/d vs aspirin 75 mg/d. In a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone. The dose of aspirin in each group was selected by the site investigator. Clopidogrel loading was defined as at least 300 mg dose (with or without aspirin) given within 6 hours of admission. Clopidogrel is an inhibitor of platelet aggregation, indicated for the prevention of ischemic stroke and in-stent thrombosis. ASA Co-administration of ASA and 150 mg dabigatran etexilate twice daily may increase the risk for any bleeding from 12% to 18% and 24% with 81 mg and 325 mg ASA, respectively (see section 4.4). In patients who need an antiplatelet effect within hours, initiate clopidogrel tablets with a single 300 mg oral loading dose and then continue at 75 mg once daily. All patients were loaded with clopidogrel at the time of the procedure. Initiating … Clopidogrel loading was defined as at least 300 mg dose (with or without aspirin) given within 6 hours of admission.
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