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Artikel ; Online: A phase 2 pharmacodynamic dose-finding, safety, and efficacy study of dalteparin for pediatric venous thromboembolism treatment in children with and without cancer.

Hartman, Lisa R / Nurmeev, Ildar / Svirin, Pavel / Wolter, Kevin D / Yan, Jean Li / Jani, Darshana / Goldenberg, Neil A / Sherman, Nancy

Pediatric blood & cancer

2022 Band 69, Heft 8, Seite(n) e29764

Abstract: Data from registrational trials of pediatric venous thromboembolism (VTE) treatment are sparse, especially among cancer patients. We conducted a prospective, multicenter, open-label trial (NCT00952380) on dose-finding, safety, and efficacy (measured by ... ...

Abstract	Data from registrational trials of pediatric venous thromboembolism (VTE) treatment are sparse, especially among cancer patients. We conducted a prospective, multicenter, open-label trial (NCT00952380) on dose-finding, safety, and efficacy (measured by 90-day risks of clinically relevant bleeding [CRB] and symptomatic recurrent VTE [srVTE]) of twice-daily subcutaneous dalteparin for acute VTE treatment in patients ≤18 years old. Among 38 patients (cancer, n = 26; noncancer, n = 12), median dalteparin dose requirements per kilogram varied with age but not cancer status. Risks of CRB and srVTE were <4% in cancer and noncancer subgroups. Dalteparin is an important FDA-approved treatment for pediatric VTE, particularly with cancer.
Mesh-Begriff(e)	Adolescent ; Anticoagulants/adverse effects ; Child ; Dalteparin/adverse effects ; Hemorrhage/chemically induced ; Hemorrhage/drug therapy ; Humans ; Neoplasms/complications ; Neoplasms/drug therapy ; Prospective Studies ; Venous Thromboembolism/drug therapy
Chemische Substanzen	Anticoagulants ; Dalteparin (S79O08V79F)
Sprache	Englisch
Erscheinungsdatum	2022-06-09
Erscheinungsland	United States
Dokumenttyp	Clinical Trial, Phase II ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2131448-2
ISSN	1545-5017 ; 1545-5009
ISSN (online)	1545-5017
ISSN	1545-5009
DOI	10.1002/pbc.29764
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Immune Tolerance Induction (ITI) with a pdFVIII/VWF Concentrate (octanate) in 100 Patients in the Observational ITI (ObsITI) Study.

Escuriola Ettingshausen, Carmen / Vdovin, Vladimír / Zozulya, Nadezhda / Svirin, Pavel / Andreeva, Tatiana / Benedik-Dolničar, Majda / Jiménez-Yuste, Victor / Kitanovski, Lidija / Zupancic-Šalek, Silva / Pavlova, Anna / Bátorová, Angelika / Montaño Mejía, Cesar / Abdilova, Gulnara / Knaub, Sigurd / Jansen, Martina / Lowndes, Shannely / Belyanskaya, Larisa / Walter, Olaf / Oldenburg, Johannes

TH open : companion journal to thrombosis and haemostasis

2022 Band 6, Heft 2, Seite(n) e124–e134

Abstract: ... ...

Abstract	Background
Sprache	Englisch
Erscheinungsdatum	2022-05-26
Erscheinungsland	Germany
Dokumenttyp	Journal Article
ZDB-ID	2901738-5
ISSN	2512-9465 ; 2567-3459
ISSN (online)	2512-9465
ISSN	2567-3459
DOI	10.1055/s-0042-1748756
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Dabigatran etexilate for the treatment of acute venous thromboembolism in children (DIVERSITY): a randomised, controlled, open-label, phase 2b/3, non-inferiority trial.

Halton, Jacqueline / Brandão, Leonardo R / Luciani, Matteo / Bomgaars, Lisa / Chalmers, Elizabeth / Mitchell, Lesley G / Nurmeev, Ildar / Sharathkumar, Anjali / Svirin, Pavel / Gorbatikov, Kirill / Tartakovsky, Igor / Simetzberger, Monika / Huang, Fenglei / Sun, Zhichao / Kreuzer, Jörg / Gropper, Savion / Reilly, Paul / Brueckmann, Martina / Albisetti, Manuela

The Lancet. Haematology

2020 Band 8, Heft 1, Seite(n) e22–e33

Abstract: Background: Dabigatran etexilate is a direct oral anticoagulant with potential to overcome the limitations of standard of care in children with venous thromboembolism. The aims of this clinical trial were to study the appropriateness of a paediatric ... ...

Abstract	Background: Dabigatran etexilate is a direct oral anticoagulant with potential to overcome the limitations of standard of care in children with venous thromboembolism. The aims of this clinical trial were to study the appropriateness of a paediatric dabigatran dosing algorithm, and the efficacy and safety of dabigatran dosed according to that algorithm versus standard of care in treating children with venous thromboembolism. Methods: DIVERSITY is a randomised, controlled, open-label, parallel-group, phase 2b/3 non-inferiority trial done in 65 centres in 26 countries. Standard of care (low-molecular-weight heparins, unfractionated heparin, vitamin K antagonists or fondaparinux) was compared with a paediatric oral dabigatran dosing regimen (an age-adjusted and weight-adjusted nomogram) in children younger than 18 years with acute venous thromboembolism initially treated (5-21 days) with parenteral anticoagulation, requiring anticoagulation therapy for at least 3 months. Patients were randomised 1:2 (standard of care:dabigatran) and stratified by age (12 to <18 years, 2 to <12 years, and birth to <2 years) via interactive response technology. The primary composite efficacy endpoint (intention-to-treat analysis) was the proportion of children with complete thrombus resolution, and freedom from recurrent venous thromboembolism and venous thromboembolism-related death. A non-inferiority margin of absolute differences of 20% was used. Secondary endpoints included safety (determined by major bleeding events [time-to-event analysis on the treated set]), and pharmacokinetic-pharmacodynamic relationships (descriptive analyses). This trial is registered with ClinicalTrials.gov, NCT01895777 and is completed. Findings: 328 children were enrolled between Feb 18, 2014, and Nov 14, 2019. 267 were randomly assigned (90 [34%] to standard of care and 177 [66%] to dabigatran) and included in the analyses. Median exposure to standard of care was 85·0 days (IQR 80·0-90·0) and to dabigatran was 84·5 days (78·0-89·0). Similar proportions of children treated with standard of care and dabigatran met the composite efficacy endpoint (38 [42%] of 90 vs 81 [46%] of 177; Mantel-Haenszel weighted difference, -0·04; 90% CI -0·14 to 0·07; p<0·0001 for non-inferiority). On-treatment bleeding events were reported in 22 (24%) of 90 children receiving standard of care and 38 (22%) of 176 children receiving dabigatran (hazard ratio [HR] 1·15, 95% CI 0·68 to 1·94; p=0·61); major bleeding events were similar between the groups (two [2%] of 90 and four [2%] of 176; HR 0·94, 95% CI 0·17 to 5·16; p=0·95). Pharmacokinetic-pharmacodynamic curves showed a linear relationship between total dabigatran plasma concentration and diluted thrombin time and ecarin clotting time, and a non-linear relationship with activated partial thromboplastin time; curves were similar to those for adults. Serious adverse events were reported for 18 (20%) of 90 children receiving standard of care and 22 (13%) of 176 children receiving dabigatran. The most common severe adverse events were vascular disorders (standard of care three [3%] of 90, dabigatran two [1%] of 176), and gastrointestinal disorders (standard of care two [2%] of 90 and dabigatran five [3%] of 176). One on-treatment death occurred in the standard of care group (retroperitoneal bleeding, not considered treatment related by the study investigators). Interpretation: An age-adjusted and weight-adjusted dabigatran dosing algorithm was appropriate in children aged birth to less than 18 years with venous thromboembolism. Dabigatran was non-inferior to standard of care in terms of efficacy, with similar pharmacokinetic-pharmacodynamic relationships as those seen in adults, and might be a suitable alternative to standard of care. Funding: Boehringer Ingelheim.
Mesh-Begriff(e)	Acute Disease ; Administration, Oral ; Adolescent ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Child ; Child, Preschool ; Dabigatran/administration & dosage ; Dabigatran/adverse effects ; Disease-Free Survival ; Female ; Humans ; Infant ; Male ; Survival Rate ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/mortality
Chemische Substanzen	Anticoagulants ; Dabigatran (I0VM4M70GC)
Sprache	Englisch
Erscheinungsdatum	2020-12-05
Erscheinungsland	England
Dokumenttyp	Clinical Trial, Phase II ; Clinical Trial, Phase III ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
ISSN	2352-3026
ISSN (online)	2352-3026
DOI	10.1016/S2352-3026(20)30368-9
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Immune Tolerance Induction (ITI) with a pdFVIII/VWF Concentrate (octanate) in 100 Patients in the Observational ITI (ObsITI) Study

TH Open

2022 Band 06, Heft 02, Seite(n) e124–e134

Abstract: Background: Immune tolerance induction (ITI) with repeated factor VIII (FVIII) administration is the only strategy proven to eradicate inhibitors. The observational ITI study is evaluating ITI with a range of FVIII products.: Methods: This subgroup ... ...

Abstract	Background: Immune tolerance induction (ITI) with repeated factor VIII (FVIII) administration is the only strategy proven to eradicate inhibitors. The observational ITI study is evaluating ITI with a range of FVIII products. Methods: This subgroup analysis reports prospective interim data for patients treated with a plasma-derived, von Willebrand factor-stabilized FVIII concentrate (pdFVIII/VWF, octanate). Complete success (CS) of ITI required achievement of three criteria: inhibitor titer < 0.6 BU/mL; FVIII recovery ≥ 66%; FVIII half-life ≥6 hours. Partial success (PS) required achievement of two criteria and partial response (PR) one. ITI success was defined as CS or PS. Data were analyzed for patients who achieved CS, had 36 months' observation, or failed ITI. Results: One-hundred prospectively enrolled patients were included in the analysis; 91 had poor prognosis factors for ITI success. The mean (standard deviation) daily ITI dose was 116.4 (61.1) IU FVIII/kg in 14 low responders (< 5 BU/mL) and 173.7 (112.0) IU FVIII/kg in 86 high responders (≥ 5 BU/mL). Inhibitor titers < 0.6 BU/mL were achieved in 71% of patients in a median of 4.01 months, accompanied by a 93% reduction in bleeding rate. ITI success was achieved by 70% of patients and 56 of 72 (78%) primary (first-line) ITI patients. PR was achieved by 5 patients; ITI failed in 25 patients. PS and CS were achieved in a median of 5.55 and 11.25 months, respectively. Conclusions: ITI with pdFVIII/VWF led to rapid eradication of FVIII inhibitors, normalization of FVIII pharmacokinetics in the majority of patients, and a significant reduction in bleeding rates.
Schlagwörter	factor VIII ; von Willebrand factor ; FVIII inhibitors ; hemophilia A ; immune tolerance
Sprache	Englisch
Erscheinungsdatum	2022-04-01
Verlag	Georg Thieme Verlag KG
Erscheinungsort	Stuttgart ; New York
Dokumenttyp	Artikel
ZDB-ID	2901738-5
ISSN	2512-9465 ; 2567-3459
ISSN (online)	2512-9465
ISSN	2567-3459
DOI	10.1055/s-0042-1748756
Datenquelle	Thieme Verlag

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Artikel ; Online: Safety of dabigatran etexilate for the secondary prevention of venous thromboembolism in children.

Brandão, Leonardo R / Albisetti, Manuela / Halton, Jacqueline / Bomgaars, Lisa / Chalmers, Elizabeth / Mitchell, Lesley G / Nurmeev, Ildar / Svirin, Pavel / Kuhn, Tomas / Zapletal, Ondrej / Tartakovsky, Igor / Simetzberger, Monika / Huang, Fenglei / Sun, Zhichao / Kreuzer, Jörg / Gropper, Savion / Brueckmann, Martina / Luciani, Matteo

Blood

2019 Band 135, Heft 7, Seite(n) 491–504

Abstract: This open-label, single-arm, prospective cohort trial is the first phase 3 safety study to describe outcomes in children treated with dabigatran etexilate for secondary venous thromboembolism (VTE) prevention. Eligible children aged 12 to <18 years (age ... ...

Abstract	This open-label, single-arm, prospective cohort trial is the first phase 3 safety study to describe outcomes in children treated with dabigatran etexilate for secondary venous thromboembolism (VTE) prevention. Eligible children aged 12 to <18 years (age stratum 1), 2 to <12 years (stratum 2), and >3 months to <2 years (stratum 3) had an objectively confirmed diagnosis of VTE treated with standard of care (SOC) for ≥3 months, or had completed dabigatran or SOC treatment in the DIVERSITY trial (NCT01895777) and had an unresolved clinical thrombosis risk factor requiring further anticoagulation. Children received dabigatran for up to 12 months, or less if the identified VTE clinical risk factor resolved. Primary end points included VTE recurrence, bleeding events, and mortality at 6 and 12 months. Overall, 203 children received dabigatran, with median exposure being 36.3 weeks (range, 0-57 weeks); 171 of 203 (84.2%) and 32 of 203 (15.8%) took capsules and pellets, respectively. Overall, 2 of 203 children (1.0%) experienced on-treatment VTE recurrence, and 3 of 203 (1.5%) experienced major bleeding events, with 2 (1.0%) reporting clinically relevant nonmajor bleeding events, and 37 (18.2%) minor bleeding events. There were no on-treatment deaths. On-treatment postthrombotic syndrome was reported for 2 of 162 children (1.2%) who had deep vein thrombosis or central-line thrombosis as their most recent VTE. Pharmacokinetic/pharmacodynamic relationships of dabigatran were similar to those in adult VTE patients. In summary, dabigatran showed a favorable safety profile for secondary VTE prevention in children aged from >3 months to <18 years with persistent VTE risk factor(s). This trial was registered at www.clinicaltrials.gov as #NCT02197416.
Mesh-Begriff(e)	Adolescent ; Child ; Child, Preschool ; Dabigatran/adverse effects ; Dabigatran/pharmacokinetics ; Dabigatran/therapeutic use ; Endpoint Determination ; Female ; Follow-Up Studies ; Humans ; Infant ; Kaplan-Meier Estimate ; Male ; Risk Factors ; Secondary Prevention ; Time Factors ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/prevention & control
Chemische Substanzen	Dabigatran (I0VM4M70GC)
Sprache	Englisch
Erscheinungsdatum	2019-12-02
Erscheinungsland	United States
Dokumenttyp	Clinical Trial, Phase III ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood.2019000998
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Use of recombinant factor VIIa in the management of severe bleeding episodes in patients with Bernard-Soulier syndrome.

Ozelo, Margareth Castro / Svirin, Pavel / Larina, Lubov

Annals of hematology

2005 Band 84, Heft 12, Seite(n) 816–822

Abstract: Bernard-Soulier syndrome (BSS) is a rare congenital platelet disorder characterized by defective platelet adhesion and manifested by spontaneous and often profuse bleeding. Recombinant factor VIIa (rFVIIa) is a haemostatic agent licensed for the ... ...

Abstract	Bernard-Soulier syndrome (BSS) is a rare congenital platelet disorder characterized by defective platelet adhesion and manifested by spontaneous and often profuse bleeding. Recombinant factor VIIa (rFVIIa) is a haemostatic agent licensed for the treatment of bleeding episodes in patients with haemophilia and inhibitors, which may represent a low-risk alternative to existing therapies in the management of patients with BSS. Here, we describe the use of rFVIIa for the treatment of three severe bleeding episodes in two patients with BSS. Data were extracted by automated searching of the international, Internet-based registry http://www.haemostasis.com . Patient 1, a 24-year-old woman, was admitted with severe epistaxis and hypotension. The diagnosis of BSS was confirmed by macrothrombocytopenia, absence of ristocetin-induced platelet agglutination (RIPA) and absence of glycoprotein (GP) Ibalpha and IX on the platelet surface. Epsilon aminocaproic acid (EACA; two 50-mg/kg doses), packed red blood cells (PRBCs, 2 U) and platelets (30 U) failed to control the bleeding and, after 13 h, three bolus doses of rFVIIa (90 microg/kg body weight) and a third dose of EACA were administered; bleeding stopped after the third dose of rFVIIa. Patient 2, a 15-year-old girl, initially presented with severe menorrhagia. A lack of RIPA and severe deficiency of GPIbalpha on the platelet surface confirmed the diagnosis of BSS. EACA and fresh-frozen plasma did not control the haemorrhage, but two bolus doses of rFVIIa (98 microg/kg body weight) resulted in a marked decrease in bleeding. On second admission, patient 2 had severe epistaxis and mild menorrhagia. Two rFVIIa doses (98 and 122.5 microg/kg body weight) were given, and the bleeding stopped. No adverse events were reported in these cases. These three admissions highlight the potential of rFVIIa for the treatment of severe bleeds in patients with BSS.
Mesh-Begriff(e)	Adolescent ; Adult ; Aminocaproic Acid/administration & dosage ; Antifibrinolytic Agents/administration & dosage ; Bernard-Soulier Syndrome/complications ; Epistaxis/etiology ; Epistaxis/therapy ; Erythrocyte Transfusion ; Factor VII/administration & dosage ; Factor VIIa ; Female ; Hemophilia A/drug therapy ; Humans ; Menorrhagia/etiology ; Menorrhagia/therapy ; Platelet Glycoprotein GPIb-IX Complex ; Platelet Membrane Glycoproteins/deficiency ; Platelet Transfusion ; Recombinant Proteins/administration & dosage
Chemische Substanzen	Antifibrinolytic Agents ; Platelet Glycoprotein GPIb-IX Complex ; Platelet Membrane Glycoproteins ; Recombinant Proteins ; glycoprotein receptor GPIb-IX ; Factor VII (9001-25-6) ; recombinant FVIIa (AC71R787OV) ; Factor VIIa (EC 3.4.21.21) ; Aminocaproic Acid (U6F3787206)
Sprache	Englisch
Erscheinungsdatum	2005-11
Erscheinungsland	Germany
Dokumenttyp	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1064950-5
ISSN	1432-0584 ; 0939-5555 ; 0945-8077
ISSN (online)	1432-0584
ISSN	0939-5555 ; 0945-8077
DOI	10.1007/s00277-005-1080-y
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Impact of inherited thrombophilia on venous thromboembolism in children: a systematic review and meta-analysis of observational studies.

Circulation

2008 Band 118, Heft 13, Seite(n) 1373–1382

Abstract: Background: The aim of the present study was to estimate the impact of inherited thrombophilia (IT) on the risk of venous thromboembolism (VTE) onset and recurrence in children by a meta-analysis of published observational studies.: Methods and ... ...

Abstract	Background: The aim of the present study was to estimate the impact of inherited thrombophilia (IT) on the risk of venous thromboembolism (VTE) onset and recurrence in children by a meta-analysis of published observational studies. Methods and results: A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2007 was conducted using key words in combination as both MeSH terms and text words. Citations were independently screened by 2 authors, and those meeting the inclusion criteria defined a priori were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, VTE type, and frequency of recurrence were abstracted. Heterogeneity across studies was evaluated, and summary odds ratios and 95% CIs were calculated with both fixed-effects and random-effects models. Thirty-five of 50 studies met inclusion criteria. No significant heterogeneity was discerned across studies. Although >70% of patients had at least 1 clinical risk factor for VTE, a statistically significant association with VTE onset was demonstrated for each IT trait evaluated (and for combined IT traits), with summary odds ratios ranging from 2.63 (95% CI, 1.61 to 4.29) for the factor II variant to 9.44 (95% CI, 3.34 to 26.66) for antithrombin deficiency. Furthermore, a significant association with recurrent VTE was found for all IT traits except the factor V variant and elevated lipoprotein(a). Conclusions: The present meta-analysis indicates that detection of IT is clinically meaningful in children with, or at risk for, VTE and underscores the importance of pediatric thrombophilia screening programs.
Mesh-Begriff(e)	Child ; Genetic Predisposition to Disease/epidemiology ; Humans ; Risk Factors ; Thrombophilia/epidemiology ; Thrombophilia/genetics ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/genetics
Sprache	Englisch
Erscheinungsdatum	2008-09-23
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.108.789008
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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