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Otten LS, Butterhoff-Terlingen MH, Mulder VC, Lagas-de Graaf W, van der Hage-Lie AM, van der Linden PD. Severe epistaxis related to intravitreal bevacizumab. Acta Ophthalmol 2020; 98:e137. [PMID: 31233274 PMCID: PMC7004067 DOI: 10.1111/aos.14176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leila S Otten
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Verena C Mulder
- Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Department of Clinical Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Mulder VC, La Heij EC, van Meurs JC. More breakdown of blood ocular barriers after vitrectomy than scleral buckling. Acta Ophthalmol 2018; 96:e894-e895. [PMID: 29098802 DOI: 10.1111/aos.13605] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Verena C. Mulder
- Rotterdam Ophthalmic Institute; Rotterdam Eye Hospital; Rotterdam The Netherlands
| | - Ellen C. La Heij
- Rotterdam Ophthalmic Institute; Rotterdam Eye Hospital; Rotterdam The Netherlands
| | - Jan C. van Meurs
- Rotterdam Ophthalmic Institute; Rotterdam Eye Hospital; Rotterdam The Netherlands
- Department of Ophthalmology; Erasmus Medical Centre; Rotterdam The Netherlands
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Bastiaans J, Mulder VC, van Meurs JC, Smits - te Nijenhuis M, van Holten - Neelen C, van Hagen PM, Dik WA. Dabigatran inhibits intravitreal thrombin activity. Acta Ophthalmol 2018; 96:452-458. [PMID: 29193875 DOI: 10.1111/aos.13630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 09/18/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Proliferative vitreoretinopathy (PVR) is a vitreoretinal disorder in which retinal pigment epithelial (RPE) cell activation contributes to both formation of fibrotic retinal membranes and inflammation. Vitreous of patients with PVR contains increased thrombin activity which induces profibrotic and proinflammatory programs in RPE cells. Inhibition of intravitreal thrombin activity may thus represent a therapeutic option for PVR. In this study, we examined the capacity of the clinically available direct thrombin inhibitor dabigatran to inhibit thrombin activity in vitreous fluids. METHODS ARPE-19 cells were cultured with the following: (i) thrombin, (ii) vitreous without thrombin activity and (iii) vitreous with elevated thrombin activity (PVR samples and thrombin spiked vitreous) either in the presence or absence of dabigatran (range: 10-5 to 10-7 M). Subsequently, CCL2, CXCL8, GMCSF, IL6 and PDGFB mRNA expression levels were determined by RQ-PCR and protein levels of 27 cytokines, chemokines and growth factors were detected in culture supernatants using a multiplex approach. In addition, the capacity of vitreous fluids obtained from patients after oral dabigatran intake was tested in an in vitro thrombin activity assay. RESULTS Thrombin and vitreous fluids containing thrombin activity induced CCL2, CXCL8, GM-CSF, IL-6 and PDGF-BB expression by ARPE-19 cells, which was inhibited by dabigatran. In addition, dabigatran that reached the vitreous after repeated oral intake did inhibit thrombin activity in the in vitro activity assay. CONCLUSION Proliferative vitreoretinopathy (PVR) is associated with increased intravitreal thrombin activity that activates profibrotic and proinflammatory pathways in RPE cells. Our findings provide evidence that this activation pathway can potentially be inhibited by dabigatran.
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Affiliation(s)
- Jeroen Bastiaans
- Departments of Immunology; Erasmus MC; Rotterdam The Netherlands
| | | | - Jan C. van Meurs
- The Rotterdam Eye Hospital; Rotterdam The Netherlands
- Ophthalmology; Erasmus MC; Rotterdam The Netherlands
| | | | | | - P. Martin van Hagen
- Departments of Immunology; Erasmus MC; Rotterdam The Netherlands
- Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | - Willem A. Dik
- Departments of Immunology; Erasmus MC; Rotterdam The Netherlands
- Laboratory Medical Immunology; Erasmus MC; Rotterdam The Netherlands
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Mulder VC, Bastiaans J, van Leuven CJM, van Meurs JC, Kluft C. Thrombin Generation in Vitreous and Subretinal Fluid of Patients with Retinal Detachment. Ophthalmologica 2018; 240:23-28. [PMID: 29617690 DOI: 10.1159/000487757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To measure prothrombin fragments (F1+2) and thrombin-antithrombin complex (TAT) in vitreous and subretinal fluid (SRF) of rhegmatogenous retinal detachment (RRD) patients and to validate and further specify our earlier finding of increased thrombin activity in patients with proliferative vitreoretinopathy (PVR). METHODS F1+2 and TAT were measured in 31 vitreous and 16 SRF samples using the Enzygnost® immunoassays. RESULTS We found significant levels of F1+2 and TAT in the vitreous of all patients with RRD compared to patients with macular hole or macular pucker. However, there was no significant difference between patients who would develop PVR in the future, had established PVR, and patients with uncomplicated RRD both in vitreous concentrations of F1+2 (Kruskal-Wallis p = 0.963) and TAT (p = 0.516). CONCLUSION The analysis of F1+2 and TAT confirmed significant thrombin generation in both vitreous and SRF of patients with RRD. An imbalance between the thrombin regulation mechanisms TAT and α2-macroglobulin possibly explains the difference from our previous findings.
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Affiliation(s)
- Verena C Mulder
- Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Jeroen Bastiaans
- Department of Immunology, Erasmus Medical Centre, Rotterdam, the Netherlands.,Department of Ophthalmology, Columbia University, New York, New York, USA
| | | | - Jan C van Meurs
- Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, the Netherlands
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Mulder VC, van Dijk EH, van Meurs IA, La Heij EC, van Meurs JC. Postoperative aqueous humour flare as a surrogate marker for proliferative vitreoretinopathy development. Acta Ophthalmol 2018; 96:192-196. [PMID: 29068530 DOI: 10.1111/aos.13560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/19/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE As some surgical procedures have been shown to increase postoperative flare values and thus contribute to blood-ocular barrier breakdown, retinal reattachment surgery might influence the risk of developing proliferative vitreoretinopathy (PVR). Therefore, we investigated whether postoperative aqueous flare values are a surrogate marker for the development of postoperative PVR. METHODS We prospectively included 195 patients with primary rhegmatogenous retinal detachment (RRD) and measured aqueous laser flare preoperatively, and at 2 and 6 weeks postoperatively. Postoperative PVR was defined as reoperation for redetachment due to PVR membranes, within 6 months of initial surgery. Logistic regression and receiver operating characteristic (ROC) analysis determined whether higher postoperative flare values were associated with an increased risk of developing PVR later on. RESULTS Reoperation for postoperative PVR was needed in 12 (6.2%) patients; in 18 (9.2%), reoperation was not related to PVR. The median flare value for patients who would develop PVR was significantly higher than that of patients who would not develop PVR, both at 2 weeks (p = 0.001) and 6 weeks (p < 0.001) postoperatively. Logistic regression analyses showed that a higher flare value significantly increased the odds of developing PVR, either at 2 weeks [odds ratio (OR) 1.027; 95% CI: 1.010-1.044] or 6 weeks (OR 1.076; 95% CI: 1.038-1.115). CONCLUSION Flare values both at 2 and 6 weeks postoperatively seem a good surrogate marker in terms of sensitivity and specificity for the development of postoperative PVR but have only a modest positive predictive value. The 2-week value would be more useful in terms of early recognition of high-risk patients and hence give the possibility to better study effects of treatment methods.
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Affiliation(s)
- Verena C. Mulder
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute; Rotterdam the Netherlands
| | - Elon H.C. van Dijk
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute; Rotterdam the Netherlands
- Department of Ophthalmology; Leiden University Medical Center; Leiden the Netherlands
| | - Ida A. van Meurs
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute; Rotterdam the Netherlands
- Department of Ophthalmology; VU Medical Center; Amsterdam the Netherlands
| | - Ellen C. La Heij
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute; Rotterdam the Netherlands
| | - Jan C. van Meurs
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute; Rotterdam the Netherlands
- Department of Ophthalmology; Erasmus Medical Center; Rotterdam the Netherlands
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Mulder VC, Kluft C, van Etten PG, La Heij EC, van Meurs JC. Higher vitreous concentrations of dabigatran after repeated oral administration. Acta Ophthalmol 2017; 95:e345-e346. [PMID: 28128536 DOI: 10.1111/aos.13348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Verena C. Mulder
- Rotterdam Ophthalmic Institute; Rotterdam Eye Hospital; Rotterdam The Netherlands
| | | | - Peter G. van Etten
- Vitreoretinal Surgery; The Rotterdam Eye Hospital; Rotterdam The Netherlands
| | - Ellen C. La Heij
- Vitreoretinal Surgery; The Rotterdam Eye Hospital; Rotterdam The Netherlands
| | - Jan C. van Meurs
- Rotterdam Ophthalmic Institute; Rotterdam Eye Hospital; Rotterdam The Netherlands
- Vitreoretinal Surgery; The Rotterdam Eye Hospital; Rotterdam The Netherlands
- Erasmus Medical Centre; Rotterdam The Netherlands
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Mulder VC, Tode J, van Dijk EH, Purtskhvanidze K, Roider J, van Meurs JC, Treumer F. Preoperative aqueous humour flare values do not predict proliferative vitreoretinopathy in patients with rhegmatogenous retinal detachment. Br J Ophthalmol 2017; 101:1285-1289. [PMID: 28077370 DOI: 10.1136/bjophthalmol-2016-309134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Patients with rhegmatogenous retinal detachment (RRD) who develop postoperative proliferative vitreoretinopathy (PVR) have been found to have higher preoperative laser flare values than patients with RRD who do not develop this complication. Measurement of laser flare has therefore been proposed as an objective, rapid and non-invasive method for identifying high-risk patients. The purpose of our study was to validate the use of preoperative flare values as a predictor of PVR risk in two additional patient cohorts, and to confirm the sensitivity and specificity of this method for identifying high-risk patients. METHODS We combined data from two independent prospective studies: centre 1 (120 patients) and centre 2 (194 patients). Preoperative aqueous humour flare was measured with a Kowa FM-500 Laser Flare Meter. PVR was defined as redetachment due to the formation of traction membranes that required reoperation within 6 months of initial surgery. Logistic regression and receiver operating characteristic analysis determined whether higher preoperative flare values were associated with an increased risk of postoperative PVR. RESULTS PVR redetachment developed in 21/314 patients (6.7%). Median flare values differed significantly between centres, therefore analyses were done separately. Logistic regression showed a small but statistically significant increase in odds with increasing flare only for centre 2 (OR 1.014; p=0.005). Areas under the receiver operating characteristic showed low sensitivity and specificity: centre 1, 0.634 (95% CI 0.440 to 0.829) and centre 2, 0.731 (95% CI 0.598 to 0.865). CONCLUSIONS Preoperative laser flare measurements are inaccurate in discriminating between those patients with RRD at high and low risk of developing PVR.
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Affiliation(s)
- Verena C Mulder
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Elon Hc van Dijk
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jan C van Meurs
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University, Rotterdam, The Netherlands
| | - Felix Treumer
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
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Mulder VC, Kluft C, van Meurs JC. Vitreous and subretinal fluid concentrations of orally administered dabigatran in patients with rhegmatogenous retinal detachment. Acta Ophthalmol 2016; 94:663-667. [PMID: 27496339 DOI: 10.1111/aos.13186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/13/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE One of the factors that was shown to contribute to the development of proliferative vitreoretinopathy (PVR) is the coagulation factor thrombin. Therefore, a specific oral thrombin inhibitor such as dabigatran might be a possible therapeutic option. An oral drug has the advantage of patient-friendly prolonged administration in contrast to drugs that can only be applied during vitrectomy, on condition that the drug reaches the target site. We tested whether dabigatran reaches the vitreous and subretinal fluid (SRF) after a single oral dose of dabigatran. METHODS Twenty-eight patients with a retinal detachment received a single dose of 220 mg dabigatran etexilate 2-8 hr prior to surgery. During surgery, we took a blood sample and a vitreous or subretinal fluid sample. The concentration of dabigatran was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS The dabigatran concentration between 2 and 9 hr after administration was higher in SRF than in vitreous (max 8.5 and 3.8 ng/ml). Corresponding plasma concentrations ranged from 15 to 225 ng/ml. There was a significant relationship between SRF levels and plasma levels (rs = 0.68, p = 0.014); the levels in vitreous fluid showed no such relationship (rs = 0.20, p = 0.48). In addition, we measured the vitreous concentration of a non-study patient using 150 mg dabigatran twice daily. The concentration was approximately 10 times higher than after a single dosage (25.8 ng/ml). CONCLUSION We demonstrate that oral intake of dabigatran, a candidate drug to modulate PVR, results in potentially relevant intraocular concentrations. We suggest that repeated dosing may lead to higher concentrations, but this should be further explored.
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Affiliation(s)
- Verena C. Mulder
- Rotterdam Ophthalmic Institute; Rotterdam Eye Hospital; Rotterdam The Netherlands
| | | | - Jan C. van Meurs
- Rotterdam Ophthalmic Institute; Rotterdam Eye Hospital; Rotterdam The Netherlands
- Erasmus Medical Centre; Rotterdam The Netherlands
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Górniak M, Proost JH, Veckeneer M, Mulder VC, Wubbels RJ. Clonidine as an adjuvant to prolong local analgesia in conventional scleral buckle surgery. J Ocul Pharmacol Ther 2014; 30:777-82. [PMID: 25188774 DOI: 10.1089/jop.2013.0243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to determine the effect of a single dose of 150 μg of clonidine as an adjuvant to levobupivacaine (Chirocaine(®)) in retrobulbar block on postoperative safety and analgesia. METHODS This was a prospective, randomized, controlled, double-blind trial. One hundred twenty patients with a rhegmatogenous retinal detachment scheduled to undergo external buckling surgery and cryocoagulation were asked to participate. Participants were randomly assigned either to receive 3-5 mL Chirocaine (22.5-37.5 mg) or 3-5 mL Chirocaine and 1 mL clonidine (150 μg) before surgery. Main outcome measures were postoperative pain, use of analgesics, blood pressure, and plasma clonidine concentration. Nine nonrandomized patients consented to give blood samples for pharmacokinetic analysis. RESULTS There was no significant difference in pain score between both groups. On average, the use of analgesic medication occurred later in the clonidine group (P=0.0004), but there was no statistical difference in the first time that postoperative medication was taken (P=0.13). Blood pressure was reduced by clonidine (systolic: P=0.02, diastolic: P=0.006). Clonidine levels could be demonstrated during the 24-h postoperative period, with an average half-life of 22 h. CONCLUSIONS Administration of clonidine as an adjuvant to conventional retrobulbar block is safe, and delays the postoperative use of analgesics. The reduction of postoperative pain and the time of first use of analgesic medication, however, were not significantly different between groups. Further, pain scores in both study groups remained low. Therefore, the beneficial effect of clonidine in conventional scleral buckle surgery appears to be limited.
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Bastiaans J, van Meurs JC, Mulder VC, Nagtzaam NMA, Smits-te Nijenhuis M, Dufour-van den Goorbergh DCM, van Hagen PM, Hooijkaas H, Dik WA. The role of thrombin in proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci 2014; 55:4659-66. [PMID: 25015355 DOI: 10.1167/iovs.14-14818] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the role of thrombin in the development of proliferative vitreoretinopathy (PVR). METHODS Vitreous was collected from patients undergoing a vitrectomy (macular holes and puckers, n = 11 [controls]; retinal detachment without PVR development following vitrectomy, n = 15 [RRD1]; retinal detachment with PVR development within 6 months after vitrectomy, n = 11 [RRD2]; and established PVR, n = 14 [PVR]). Thrombin activity in vitreous was determined using a thrombin-specific chromogenic substrate. ARPE-19 cells were stimulated with 8× diluted vitreous samples in the presence and absence of hirudin. The samples were analyzed at t = 0 and t = 24 hours for the presence of 27 cytokines/chemokines and growth factors using a multiplex approach. In comparable studies, ARPE-19 cells were stimulated for 2 hours, and mRNA expression levels for CCL2, CXCL8, GMCSF, IL6, and PDGFB were determined by real-time quantitative (RQ)-PCR. RESULTS Thrombin activity was significantly (P < 0.05) higher in vitreous of the PVR group compared to the other groups. Proliferative vitreoretinopathy vitreous stimulated the production of chemokine (C-C motif) ligand (CCL)2, chemokine (C-X-C motif) ligand (CXCL)8, granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-6, and platelet-derived growth factor (PDGF)-BB by ARPE-19 to significantly (P < 0.05) higher levels than vitreous from the RRD1 and RRD2 groups. These effects of PVR vitreous were significantly (P < 0.05) reduced by hirudin. These data were confirmed by mRNA studies. CONCLUSIONS Thrombin activity is increased in vitreous of patients with established PVR and is involved in the activation of proinflammatory and profibrotic pathways in RPE cells. Inhibition of thrombin activity may therefore represent a potential treatment option for proliferative vitreoretinopathy.
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Affiliation(s)
- Jeroen Bastiaans
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan C van Meurs
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | | | - Nicole M A Nagtzaam
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | | | - P Martin van Hagen
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Herbert Hooijkaas
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Willem A Dik
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Mulder VC, Oudemans-Van Straaten HM, Zandstra DF, Franssen EJ. Massive ingestion of cardiac drugs: toxicokinetic aspects of digoxin and sotalol during hemofiltration. Clin Toxicol (Phila) 2010; 48:218-21. [DOI: 10.3109/15563650903544132] [Citation(s) in RCA: 3] [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: 11/13/2022]
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