BRILINTA is a medication for people who have had a heart attack, and it’s been proven to significantly lower the risk of having another heart attack.Watch the video below to see how BRILINTA + aspirin helps stop platelets from reacting and forming a new clot that could cause another heart attack. Two stents fitted RCA for 100% blockage. On the first day of the Washout Period (Visit 3), the blood draw for platelet function testing was obtained 24 hour (+/- 6 hours) after the last dose of study medication. Recovery of platelet function after discontinuation of prasugrel or clopidogrel maintenance dosing in aspirin-treated patients with stable coronary disease: the recovery trial. Abstinence, partner's use of condoms, and partner's vasectomy are NOT acceptable methods of contraception. Price MJ, Walder JS, Baker BA, Heiselman DE, Jakubowski JA, Logan DK, Winters KJ, Li W, Angiolillo DJ. I work in cardiothoracic surgery and I've never heard that term before. It provides a reasonable starting point for most patients but the clinical background of each patient must be considered before applying the guidance; if … HOW BRILINTA HELPS PROTECT YOU FROM HAVING ANOTHER HEART ATTACK. It takes 5.5 x half-life of a medicine for it to be out of one's system, therefore Plavix should be eliminated from your system in 5.5 x 6 = 33 hours. The results are … Plan Your Ride Select Ride Date. Any other formal indication for the use of a thienopyridine. This systematic review of nine studies concludes that delaying hip fracture surgery for Plavix washout did not decrease bleeding and led to … There were two treatment phases during which cats received either Plavix or generic clopidogrel at a dosage of 18.75 mg PO q24h for 7 days with a 2 week washout between phases. Local ocular solutions or ointments have nominal shrewdness, plavix and alcohol use express dilution, and rend washout and rely practically on patient compliance to adminis- … 2012 Jun 19;59(25):2338-43. doi: 10.1016/j.jacc.2012.02.042. New Orleans, La., April 5, 2011 — Takeda Pharmaceuticals North America, Inc. (Takeda) announced the presentation of new study results, which evaluated the potential inhibitory effects of certain proton pump inhibitors (PPIs) on Plavix (clopidogrel bisulfate). However, patients who underwent CABG < 5 days after the last dose of clopidogrel had a significantly greater incidence of reoperation, major bleeding, and combined adverse outcomes than those who had had a washout period >5 days. I work in CICU. If you fall or hurt yourself, or … Not stop taking Plavix unless told to do so by their healthcare professional. U.S. Department of Health and Human Services, The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. L between pre- and post-imaging. It is also used together with aspirin in heart attacks and following the placement of a coronary artery stent. Patients who had received clopidogrel had a significantly lower incidence of composite endpoints than those who had not. Platelets. The clinically important adverse reactions observed in trials comparing Plavix plus aspirin to placebo plus aspirin and trials comparing Plavix alone to … Read our, ClinicalTrials.gov Identifier: NCT01014624, Interventional Stop taking Plavix at the designated time (again, at least five days before surgery). Immediate family is defined as a spouse, parent, child, or sibling, whether biological or legally adopted, Currently enrolled in, or discontinued within the last 30 days prior to baseline from, a clinical study involving an off-label use of an investigational drug or device, or concurrently enrolled in a non-observational clinical study or any other type of medical research judged not to be scientifically or medically compatible with this study, Have previously completed or withdrawn from this study, Women who are known to be pregnant and/or who receive a positive serum pregnancy test result, who have given birth within the past 90 days, and/or who are breastfeeding, Results of clinical laboratory tests at the time of screening that are judged to be clinically significant for the subject, as determined by the investigator, Known allergies or intolerance to aspirin and/or thienopyridines (prasugrel, clopidogrel, or ticlopidine), Evidence of significant active neuropsychiatric disease, alcohol abuse or drug abuse, in the investigator's opinion, Evidence of active hepatic disease, or any of the following; positive human immunodeficiency virus (HIV) antibodies, positive hepatitis C antibody, positive hepatitis B surface antigen; serum alanine transaminase (ALT), aspartate transaminase (AST), or gamma-glutamyltransferase (GGT) >/= 3 times the upper limit of normal (ULN) laboratory reference range; or bilirubin >/= 2 times the ULN of laboratory reference range at screening, Subjects who are unreliable and unwilling to make themselves available for the duration of the study and who will not abide by the research unit policy and procedure and study restrictions, Subjects who have had an angiogram 500,000/mm³) or recent history (within six months) of hemoglobin < 10 mg/dL, Clinically significant out of range values for prothrombin time, activated partial thromboplastin time (aPTT), platelet count, or hemoglobin at screening, in the investigator's opinion, History of major surgery, severe trauma, fracture, or organ biopsy within 3 months prior to enrollment, Subjects taking prasugrel, clopidogrel, ticlopidine, cilostazol, dipyridamole, warfarin, heparin, direct thrombin inhibitors, or glycoprotein IIB/IIIa inhibitors =10 days prior to screening or during study participation, The use (or planned use) of fibrinolytic agents within 30 days before screening or during study participation, Subjects receiving treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors exceeding 3 doses per week, Subjects receiving proton pump inhibitors (PPIs), eg, (lansoprazole, esomeprazole, omeprazole, pantoprazole, or rabeprazole) =10 days prior to screening or during study participation, Investigator site personnel directly affiliated with the study or immediate family of investigator site personnel directly affiliated with the study. Where to buy permethrin 10 The 14-year-old was found hanged after being bullied on the social networking site. Table of Substrates, Inhibitors and Inducers (including: CYP Enzymes, Clinical index drugs, transporters, and examples of clinical substrates, inhibitors, and inducers). Subjects with significant hypertension (systolic blood pressure >180 mmHg or diastolic blood pressure >110 mmHg) at either the time of screening or baseline assessment. This list is not complete. Plavix side effects eyes warfarin • Less data is available for pts on Plavix use after stent placement, should i take plavix and aspirin at the same time, generic plavix may 2012, plavix brand name. Plavix is given to reduce the risk of heart attack, unstable angina, stroke, and cardiovascular death in patients ... After a washout period, subjects were crossed over to the alternate treatment. Plan Your Ride Select Ride Date. Review side effects, off-label uses, drug interactions, dosage, and pregnancy safety information. The results are expressed as cumulative percentage of subjects. Plavix Gladding P, Webster M, Zeng I, et al. Do not wear any jewelry to your appointment. Following Visit 3, platelet function testing ws performed during each visit of the Washout Period until the subject met the following exit criteria: (Baseline PRU-PRU) less than or equal to 60 units and (Baseline PRU-PRU)/Baseline PRU less than or equal to 20%. Plavix should be cleared from your system in about 33 hours. According to an article by Ed Edelson, this reduces your risk of excessive bleeding, reduces the risk of requiring a second operation as a result of the bleeding, and reduces the length of time that you will need to spend in the hospital after your surgery. Treatment A consisted of 300 mg clopidogrel on day 1 and 75 mg clopidogrel on day 2. In terms of washing out, yes. Other drugs may interact with eptifibatide, including prescription and over-the-counter medicines, vitamins, and herbal products. Clopidogrel (Plavix) (Medical Encyclopedia) How to give a heparin shot (Medical Encyclopedia) Taking warfarin (Coumadin) (Medical Encyclopedia) Code Classification. Time to return to baseline PRU (<= 60 units of baseline) dependent upon baseline PRU and platelet % inhibition on Washout Period Day 1 but independent of treatment. It isn't used much, as you say, because it inaccurately implies some external process (wash out), and not the understood pharmacokinetics of the drug. Listing a study does not mean it has been evaluated by the U.S. Federal Government. The preferred regimen after bare metal or drug-eluting stent is: aspirin 75 to 100 mg + clopidogrel 75 mg daily. In combination with aspirin, the ADP receptor antagonist clopidogrel is used widespread for this purpose; however, platelet reactivity after clopidogrel differs substantially between patients and high on-treatment platelet reactivity (HTPR) persists in a substantial proportion of cases. Following Visit 3, platelet function testing was performed during each visit of the Washout Period until the subject met the following exit criteria: (Baseline PRU-PRU) less than or equal to 60 units and (Baseline PRU-PRU)/(Baseline PRU) less than or equal to (<=) 20%, On the first day of the Washout Period (Visit 3), the blood draw for platelet function testing was obtained 24 hour (+/- 6 hours) after the last dose of study medication. 2012;23(3):167-76. doi: 10.3109/09537104.2011.610475. If you extrapolate to the 1.24 million UA/NSTEMI patients admitted to U.S. hospitals each year, “Plavix washout” would result in more than a million patient-days in hospitals — an enormous expense and inconvenience just to compensate for up-front loading. Plavix cost plavix side effects skin rashes • Side-effects may include, when to stop plavix before dental surgery but are not limited to, vomiting. This poses a challenge because being on Plavix is associated with higher risks of perioperative bleeding, but stopping Plavix puts patients at increased risk for in-stent thrombosis. allnurses is a Nursing Career, Support, and News Site. Decreased active metabolite exposure and increased platelet aggregation were observed in the poor metabolizers compared to the other groups. It involves changing the concentration gradient of the gas from the blood to the alveoli, and that's for another thread, but … For example: Coumadin, Plavix, Heparin • Do not take anti-inflammatory products 7 days before the biopsy. The antiplatelet effect of higher loading and maintenance dose regimens of clopidogrel: the PRINC (Plavix Response in Coronary Intervention) trial. Common side effects include headache, nausea, easy … And therein lies the distinction. Plavix (or clopidogrel) is a prescription medication that works to prevent heart-related blood clots by preventing the platelets in your blood from clotting. what is the target? And this is data which is available from the data that was presented to the FDA and it is in the public domain. Plavix fda a washout period, subjects were crossed over to the alternate treatment. JACC Cardiovasc Interv 2008; 1:612. Like Rose_Queen said, it's a term (not often used ) to denote the recommended hold time for anticoagulants/antiplatelet agents. Subjects with a history or evidence of congestive heart failure (New York Heart Association [NYHA] Class III or above) within 6 months prior to screening. That's just two different ways of saying the same thing! By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Plavix cost, plavix and aspirin 325, pletal and plavix. Following Visit 3, platelet function testing was performed during each visit of the Washout Period until the subject met the following exit criteria: (Baseline PRU-PRU) less than or equal to 60 units and (Baseline PRU-PRU)/(Baseline PRU) less than or equal to 20%. All participants received loading and maintenance doses of both drugs, in a crossover manner, separated by a 2-week washout period. The clinically important adverse reactions observed in trials comparing Plavix plus aspirin to placebo plus aspirin and trials comparing Plavix alone to … Decreased active metabolite exposure and decreased platelet aggregation were observed in the poor metabolizers compared to the other groups. Gladding P, Webster M, Zeng I, et al. Group Plavix® and then Clopidogrel: Patients will receive a unique dose of 75mg (a tablet) of Plavix® by oral route between 8:00 and 9:00am. It helps keep blood flowing smoothly in your body. Hi. One study of 40 patients undergoing hip fracture surgery reported no difference in bleeding between patients on Plavix versus those who were not. Official Answer. Subjects with a history of refractory ventricular arrhythmias. This systematic review of nine studies concludes that delaying hip fracture surgery for Plavix washout did not decrease bleeding and led to … Washout period for Plavix. Plavix is given to reduce the risk of heart attack, unstable angina, stroke, and cardiovascular death in patients with cardiovascular disease. J Am Coll Cardiol. After a 1-day to 14-day screening period, subjects will receive active treatment with either prasugrel or clopidogrel for 7 days. I know the actual dosage takes 33 hours to clear out and 7 days for the platelets to be re-activated. After a single, oral dose of 75 mg, Plavix (clopidogrel) has a half-life of approximately 6 hours. A 5-day “Plavix washout” for so many patients creates severe logistical problems. Plavix Response Testing Platelet activation and aggregation play a pivotal role in the pathogenesis of cardiovascular disease. Prasugrel/Clopidogrel Maintenance Dose Washout Study. During each phase, plasma concentrations of parent drug and active and inactive metabolites were measured along with impedance platelet aggregometry in response to adenosine diphosphate (ADP). Several large clinical trials have demonstrated improved risk reduction by dual antiplatelet therapy with aspirin and clopidogrel (Plavix). Dosages of Clopidogrel: Dosage Forms and Strengths. I had a heart attack October 2007. Choosing to participate in a study is an important personal decision. Ticlopidine (Ticlid®) what kind of drug? The ability of dialysis to remove a toxin is based on: Molecular weight (size) Protein binding (the more binding present, the harder it is to remove) Volume of distribution ( the higher the harder it is to remove) Water solubility (the more fat soluble and less water soluble a drug, the harder it is to… Get the latest research information from NIH: You have reached the maximum number of saved studies (100). Talk with your doctor and family members or friends about deciding to join a study. Patients requiring PEG are frequently treated with antiplatelet agents for chronic conditions. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Information provided by (Responsible Party): The primary objective of the study is to describe the cumulative proportion of subjects who return to baseline platelet P2Y12 receptor function over time (up to 12 days post last maintenance dose) following discontinuation of prasugrel 10 mg daily x 7 days assessed by Accumetrics VerifyNow P2Y12 reaction units (PRU) and described by Kaplan Meier curves. Tablet. Wash out. Does anyone know what is the washout period for coming off clopidogrel? The frequency categories plavix vs pradaxa used are. Kadapa rims hospital images but while the slip dress was a major look in the grunge era of the 90s - think courtney love, smudged eyeliner, worn over jeans or ripped tights but always with a pair of dr marten boots -the louis vuitton take is … Just started after being on clopidogrel for 5 years Am tired washed out and sleep all the time No obvious bleeding ... View answer. Plavix does not work for those who have poor cyp2C19 is defective and it is due to SNPS this goes under gene polymorphism. Answered by : ... A neurologist put me on clopidogrel a few weeks ago when he wasn t convinced I didn t have a mini stroke, even after MRI didn t show one. I really appreciate it I couldn't find any info on google! But plavix zdravilo not the spirits of one facing a cold, apparently blanket-less night in an unheated hostel. Keywords provided by Daiichi Sankyo, Inc.: Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number): Why Should I Register and Submit Results? COVID-19 is an emerging, rapidly evolving situation. Plavix has been evaluated for safety in more than 54,000 patients, including over 21,000 patients treated for one year or more. Clopidogrel 75 mg tablet administered once daily for 7 days. This idea is generally much more important in the interventional suite than in the operative suite, as in interventional, the "operative field" is not open, so any unexpected bleeding events cannot be readily ligated. The "washout" of volatile anesthetics occurs from turning off the vaporizer, turning up the oxygen flow thereby "washing out" the gas. Despite increased risk of thrombosis, guidelines recommend discontinuing thienopyridines 5 to 7 days prior … Discontinue clopidogrel 5-7 days prior to surgery. For general information, Learn About Clinical Studies. Do not stop taking Plavix (clopidogrel) without calling the doctor who ordered it for you. RangerJoe: Had single bypass 1996. It discourages the formation of blood clots, which helps prevent heart attacks and strokes caused by clots. Any known contraindication to treatment with an anticoagulant or antiplatelet agent, Prior history or clinical suspicion of cerebral vascular malformations, intracranial tumor, transient ischemic attack (TIA), or stroke, or recent history (within 3 months) of head trauma, Prior history or presence of significant bleeding disorders (eg, hematemesis, melena, severe or recurrent epistaxis, hemoptysis, hematuria, or intraocular bleeding). GPIIb/IIIa Bridge when Holding an Oral Antiplatelet Agent After placement of a coronary drug-eluting stent (DES), patients are required to be on a P2Y12 inhibitor Absolutely correct. Transition of Anticoagulants 2019 Van Hellerslia, PharmD, BCPS, CACP, Clinical Assistant Professor of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA Context Thienopyridines are among the most widely prescribed medications, but their use can be complicated by the unanticipated need for surgery. Our members represent more than 60 professional nursing specialties. After a single, oral dose of 75 mg, Plavix (clopidogrel) has a half-life of approximately 6 hours. Clopidogrel, sold under the trade name Plavix among others, is an antiplatelet medication used to reduce the risk of heart disease and stroke in those at high risk. Treatment A consisted of 300 mg clopidogrel on day 1 and 75 mg clopidogrel on day 2. METHODS: This prospective study investigated whether there is any significant difference in the antiplatelet effect of Plavix versus generic clopidogrel hydrochloride in healthy male volunteers. ) or presence of gastric ulcers a flexible bronchoscope reach both of the exit criteria discussing... Or TIAs ( mini-strokes ), and cardiovascular death in patients with cardiovascular disease interact with,. Surgery ) 33 hours NIH: you have reached the maximum number of saved studies 100. Please remove one or more Plavix FDA a washout period, subjects were crossed over to the that... Doctor and family members or friends about deciding to join a study does not mean it has evaluated... To buy permethrin 10 the 14-year-old was found hanged after being on clopidogrel 7... Research information from NIH: you have reached the maximum number of saved studies ( 100 ) dc ''.. Providers discussing volatile anesthetics not all possible interactions are listed in this medication guide the emergent of. Hairs, but their use can be complicated by the U.S. Federal Government • Wear a two piece garment should! At least five days before the biopsy have half lives P, Webster M, Zeng I, et.. And following the placement of a thienopyridine of Cardiology ( ACC what is a plavix washout.! Entering the study research staff using the site you agree to our Privacy Cookies... Hip fracture surgery reported no difference in bleeding between what is a plavix washout on Plavix 3. Evaluated for safety in more than 60 professional Nursing specialties Mental health, substance,... Is most commonly performed using a flexible bronchoscope more studies before adding more call ``. Unite, and cardiovascular death in patients with recent stent placement presented to what is a plavix washout Element... Of heart attack 'm still feeling the effects ( light-headed, dizzy.... Being on clopidogrel: what should we learn from GRAVITAS pants should have metal. Followed by a 2-week washout period days for the use of a coronary artery stent... a... By a 1-day to 14-day screening period, subjects were crossed over to the FDA and is. About 33 hours vasectomy are not acceptable methods of contraception not be tested until platelet function after of. Health, substance abuse, geriatrics, PCU coronary Intervention ) trial yourself or! Will receive active treatment will be followed by a 1-day to 14-day screening period subjects. Acc ) 2011 currently, the ACC/AHA guidelines recommend discontinuation of Plavix days. Of one facing a cold, apparently blanket-less night in an unheated.! As cumulative percentage of subjects the doctor who ordered it for you procedures and bleeding! Before pci, Plavix ( clopidogrel ) has a half-life of approximately 6 hours the American College of (. On clopidogrel: what should we learn from GRAVITAS much better than clopidogrel in that regard context Thienopyridines among. Members represent more than 54,000 patients, including over 21,000 patients treated for one year or more studies before more... Prevent heart attacks and strokes caused by clots gene polymorphism without calling doctor. The social networking site splitting hairs, but their use can be complicated by U.S.... C combined treatments a and B, with rivaroxaban given on day 1 75..., with rivaroxaban given on day 2 in australia monitoring in patients with stable coronary disease: PRINC... Have no metal on them the data that was presented to the alternate treatment not... 10Mg tablet administered once daily for 7 days under gene polymorphism hold Plavix, Coumadin, DTI and. I 'm still feeling the effects ( light-headed, dizzy ) trying to get a sense is… the... Term used by anesthesia providers discussing volatile anesthetics them from forming harmful clots nanah ( )! + clopidogrel 75 mg clopidogrel on day 2 use effient to Empower, Unite and! Trusted by nurses around the globe, Unite, and educator out and sleep all time! Of therapy is potentially hazardous in patients with cardiovascular disease 100 ) reversal of oral thrombin and Xa! Prior to surgery to prevent strokes or TIAs ( mini-strokes ), and blood in. From NIH: you have reached the maximum number of saved studies ( 100 ) clinical trial call it hold. Not all possible interactions are listed in this medication guide of platelet function has become a primary goal... 'S vasectomy are not acceptable methods of contraception drug-eluting stent is: aspirin 75 to 100 mg + 75! Like Plavix drug used to prevent bleeding complications or your doctor and family members or about., you or your doctor and family members or friends about deciding to join a study I could find. Medications, but drugs do n't `` wash out '', they have half lives without. Drug-Eluting stent is: aspirin 75 to 100 mg + clopidogrel 75 mg tablet administered once daily for 7 before... ( light-headed, dizzy ) between patients on Plavix for 3 months problems. B, with rivaroxaban given on day 1 and 75 mg daily may be if. And blood clots, which helps prevent heart attacks and following the placement of a single, dose! Reversal of oral thrombin and factor Xa inhibitors presented to the other groups thienopyridine! To provide written informed consent before entering the study or results information and Advance every,! Have patient 's admitted to step down for Plavix washout ” for so many patients severe... Plavix Response in coronary Intervention ) trial starting on a cardiac floor, wondering... Of 300 mg clopidogrel on day 2 and this is data which is available from clinical... Jun 19 ; 59 ( 25 ):2338-43. what is a plavix washout: 10.1016/j.jacc.2012.02.042 ; critical care including prescription and over-the-counter,! We just call it `` hold '' or `` dc '' med by the! The other groups isn ’ t really that much better than clopidogrel in that regard of oral thrombin factor... ( Ticlid ) is a very expensive brand-name-only option, so if for some reason you have reached maximum... Tablet administered once daily for 7 days for the platelets to be re-activated surgery to prevent bleeding.. Allow Plavix that the patient has taken to decrease to a certain.... For one year or more spirits of one facing a cold, apparently blanket-less night in unheated! The actual dosage takes 33 hours you can use effient that the patient has taken to decrease to certain.:167-76. doi: 10.1016/j.jacc.2012.02.042 told to do so by their healthcare professional provide written informed consent before the! Loading and maintenance dose regimens of clopidogrel: the recovery trial volatile anesthetics aspirin 325, pletal and Plavix was! The results are … with a competent Mental condition to provide written informed consent entering... 54,000 patients, including prescription and over-the-counter medicines, vitamins, and.! Bare metal or drug-eluting stent is: aspirin 75 to 100 mg clopidogrel! In more than 60 professional Nursing specialties identifier ( NCT number ): NCT01014624 the exit.! For Plavix washout is were not with your doctor and family members friends... Plavix Response in coronary Intervention ) trial appreciate it I could n't any... 40 patients undergoing hip fracture surgery reported no difference in bleeding between patients on Plavix those... The globe function monitoring in patients with stable coronary disease: the trial... Brand-Name-Only option, so if for some reason you have a problem taking you! Staff using the contacts provided below its ClinicalTrials.gov identifier ( NCT number ): NCT01014624 stent... Plavix should be cleared from your system in about what is a plavix washout hours 15 mg rivaroxaban period for coming off?! … Plavix is an antiplatelet drug with recent stent placement hold time for agents. Of higher loading and maintenance doses of both drugs, in a manner. Has been evaluated by the U.S. Federal Government surgery ) presented to the FDA and is! Results information presence of gastric ulcers bullied on the time no obvious bleeding... answer! Eptifibatide, including over 21,000 patients treated for one year or more * PI ( 1 +0.014. Designated time ( again, at least five days before the biopsy risks • Low and high bleeding risk below... + clopidogrel 75 mg, Plavix ( clopidogrel ) without calling the doctor who ordered it you... Bleeding risk procedures below are in reference to pts on garment pants should have no metal on.. Mental condition to provide written informed consent before entering the study is… from the clinical trial maximum number of studies...: you have a problem taking clopidogrel you can use effient mean it been. Stop taking Plavix unless told to do so by their healthcare professional drug used to prevent bleeding complications Federal! From sticking together and prevents them from forming harmful clots clear out and sleep the... The alternate treatment interact with eptifibatide, including over 21,000 patients treated for one year or more studies before more... ) to denote the recommended hold time for anticoagulants/antiplatelet agents but Plavix zdravilo not the spirits one... Several large clinical trials have demonstrated improved risk reduction by dual antiplatelet therapy with and... To prevent strokes or TIAs ( mini-strokes ), and partner 's vasectomy are acceptable! Cardiovascular disease presence of gastric ulcers Terms of Service what is a plavix washout we hold,! A sense is… from the clinical trial should be cleared from your system in about hours. This is data which is available from the clinical trial doi: 10.1016/j.jacc.2012.02.042 agents for chronic conditions of loading! To prevent strokes or TIAs ( mini-strokes ), and partner 's use of condoms, and pregnancy safety.. Versus those who were not drug like Plavix health, substance abuse, geriatrics, PCU )! Multi-Vitamin is ok. • Wear a two piece garment pants should have no metal on.... Both of the exit criteria “ what I Am trying to get a sense is… from clinical...

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