4,147 results match your criteria Heparin-Induced Thrombocytopenia

Evaluation of laboratory assays for anti-Platelet Factor 4 antibodies after ChAdOx1 nCOV-19 vaccination.

J Thromb Haemost 2021 May 10. Epub 2021 May 10.

Oxford University Hospitals NHS Foundation Trust.

Vaccine-induced immune thrombocytopenia and thrombosis (VITT) following ChAdOx1 nCOV-19 vaccine has been described, associated with unusual site thrombosis, thrombocytopenia, raised D-dimer and high titre immunoglobulin-G (IgG) class anti-Platelet Factor 4 (PF4) antibodies. Enzyme linked immunosorbent assays (ELISA) have been shown to detect anti-PF4 in patients with VITT, but chemiluminesence assays do not reliably detect them. ELISA assays are not widely available in diagnostic laboratories, and, globally, very few laboratories perform platelet activation assays. Read More

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LVAD as a bridge to decision complicated with pump thrombosis and infection.

Indian J Thorac Cardiovasc Surg 2021 May 9;37(3):341-344. Epub 2021 Jan 9.

Department of Cardiothoracic Anesthesia, Freeman Hospital Newcastle Upon Tyne NHS Trust, Freeman Rd, High Heaton, Newcastle upon Tyne, NE7 7DN UK.

Left ventricular assist devices (LVADs) emerged as an effective therapy for the treatment of symptomatic advanced heart failure in spite of maximum tolerated optimal medical treatment. LVADs were initially conceived as a bridge to transplantation, although with the continuing donor shortage, they also serve as a definitive therapy for some patients. Careful evaluation by a multidisciplinary team and proper patient selection are key factors for good outcomes. Read More

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Fondaparinux Pre-, Peri-, and/or Postpartum for the Prophylaxis/Treatment of Venous Thromboembolism (FondaPPP).

Clin Appl Thromb Hemost 2021 Jan-Dec;27:10760296211014575

Aspen Pharma, München, Germany.

We analyzed data for women who received fondaparinux for ≥7 days during pregnancy. The study retrospectively included women who received fondaparinux pre-, peri- and/or postpartum for ≥7 days for prophylaxis/venous thromboembolism (VTE) treatment at German specialist centers (2004-2010). Data on pregnancy, VTE risk factors, anticoagulant treatment, pregnancy outcome and adverse events were extracted from medical records. Read More

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The Triple HIT: Perioperative Management of Heparin-Induced Thrombocytopenia Using Plasma Exchange, Intravenous Immunoglobulin, and Protamine Infusion for Left Ventricular Assist Device Implantation.

J Cardiothorac Vasc Anesth 2021 Mar 30. Epub 2021 Mar 30.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.

Heparin-induced thrombocytopenia (HIT) is a serious complication in patients exposed to heparin, leading to thrombocytopenia and, potentially, thrombosis. This disorder is challenging in cardiac surgery when anticoagulation for cardiopulmonary bypass is required. Herein a patient with HIT who had active thrombosis and successfully underwent urgent left ventricular assist device implantation managed with plasma exchange, intravenous immunoglobulin, and protamine infusion is described. Read More

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US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021.

JAMA 2021 Apr 30. Epub 2021 Apr 30.

Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia.

Importance: Cerebral venous sinus thrombosis (CVST) with thrombocytopenia, a rare and serious condition, has been described in Europe following receipt of the ChAdOx1 nCoV-19 vaccine (Oxford/AstraZeneca), which uses a chimpanzee adenoviral vector. A mechanism similar to autoimmune heparin-induced thrombocytopenia (HIT) has been proposed. In the US, the Ad26. Read More

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Argatroban versus heparin in patients without heparin-induced thrombocytopenia during venovenous extracorporeal membrane oxygenation: a propensity-score matched study.

Crit Care 2021 04 29;25(1):160. Epub 2021 Apr 29.

Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.

Background: During venovenous extracorporeal membrane oxygenation (vvECMO), direct thrombin inhibitors are considered by some potentially advantageous over unfractionated heparin (UFH). We tested the hypothesis that Argatroban is non-inferior to UFH regarding thrombosis and bleeding during vvECMO.

Methods: We conducted a propensity-score matched observational non-inferiority study of consecutive patients without heparin-induced-thrombocytopenia (HIT) on vvECMO, treated between January 2006 and March 2019 in the medical intensive care unit at the University Hospital Regensburg. Read More

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Is the HIT-like syndrome associated with ChAdOx vaccine related to the vaccine itself or an autoimmune reaction to SARS-CoV-2, insights and implications from previous reports in infected cases?

New Microbes New Infect 2021 Apr 23:100884. Epub 2021 Apr 23.

Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Egypt.

Prothrombotic states, similar to Heparin induced thrombocytopenia (HIT) in recipients of the ChAdOx vaccine, sounded alarm bells internationally. Equivalent episodes of HIT were detailed in several case reports of Coronavirus Disease 2019 (COVID-19) patients. This suggests a common pathogenesis and warrants a shift in the management of implicated cases. Read More

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Heparin-induced thrombocytopenia.

CMAJ 2021 Apr 27. Epub 2021 Apr 27.

Departments of Medicine (Jevtic, Warkentin, Pai) and Pathology and Molecular Medicine (Warkentin), McMaster University, Hamilton, Ont.; Department of Medicine (Morris), Sinai Health, University Health Network; Faculty of Medicine (Morris), University of Toronto, Toronto, Ont.

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Accuracy of the functional, flow cytometer-based Emo-Test HIT Confirm® for the diagnosis of heparin-induced thrombocytopenia.

Thromb Res 2021 Apr 19;203:22-26. Epub 2021 Apr 19.

Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland; University of Bern, Bern, Switzerland. Electronic address:

Introduction: Rapid functional assays have been proposed to overcome the limitations of washed platelet assays in the work-up of patients with suspected heparin-induced thrombocytopenia (HIT). Data on the diagnostic accuracy are, however, scarce and conflicting. We aimed to study the diagnostic accuracy of a rapid, flow cytometer-based assay and to explore sources of variability. Read More

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Evaluation of 4Ts score inter-rater agreement in patients undergoing evaluation for heparin-induced thrombocytopenia.

Blood Coagul Fibrinolysis 2021 Apr 23. Epub 2021 Apr 23.

Department of Pharmacy, University of North Carolina Medical Center School of Medicine Translational and Clinical Sciences Institute, University of North Carolina, Chapel Hill, North Carolina Department of Pathology, University of New Mexico, Albuquerque, New Mexico Division of Hematology Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.

The American Society of Hematology and American College of Chest Physicians heparin-induced thrombocytopenia guidelines recommend calculation of a pretest probability score prior to performing laboratory testing, and the 4Ts score is commonly used. Inter-rater agreement of the 4Ts score has been evaluated, but limited data are available regarding the reliability of the 4Ts score when performed by nonexpert clinicians. The purpose of this study was to Compare 4Ts scores calculated by medical teams to an expert. Read More

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Editorial: SARS-CoV-2 mRNA Vaccines and the Possible Mechanism of Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT).

Dinah V Parums

Med Sci Monit 2021 Apr 26;27:e932899. Epub 2021 Apr 26.

Science Editor, International Scientific Information, Cambridge, United Kingdom.

During 2020 and 2021, the global pandemic of coronavirus disease 2019 (COVID-19) due to severe acute respi- ratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in high death rates and acute and chronic morbidity in all countries. The rapid development of new mRNA vaccines to SARS-CoV-2 brings hope that the spread of this virus can be controlled. The ChAdOx1 nCoV-19 vaccine developed by a collaboration between the University of Oxford and AstraZeneca showed efficacy in clinical trials, with a good safety profile. Read More

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Research on clinical characteristics and prognostic analysis of heparin-induced thrombocytopenia after surgery for acute type a aortic dissection.

J Cardiothorac Surg 2021 Apr 20;16(1):96. Epub 2021 Apr 20.

Department of Critical Care Medicine ICU, Fu Wai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, China.

Purpose: The present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis.

Methods: After continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Read More

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Guideline No. 417: Prevention of Venous Thromboembolic Disease in Gynaecological Surgery: (En français : Prévention de la maladie thromboembolique veineuse en chirurgie gynécologique).

J Obstet Gynaecol Can 2021 Apr 17. Epub 2021 Apr 17.

Hamilton, ON.

Objective: The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the use of thromboprophylaxis in gynaecological surgery.

Target Population: All patients undergoing gynaecological surgery for benign or malignant indications.

Benefits, Harms, And Costs: The implementation of this guideline will benefit patients undergoing gynaecological surgery and provide physicians with a standard algorithm for the use of perioperative thromboprophylaxis. Read More

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False-positive heparin-PF4 latex immunoturbidimetric assay due to lupus anti-coagulant interference: a case report.

Br J Haematol 2021 Apr 20. Epub 2021 Apr 20.

Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Hemostasis and Thrombosis Unit, University of Rochester Medical Center, Rochester, NY, USA.

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Thrombocytopenia with acute ischemic stroke and bleeding in a patient newly vaccinated with an adenoviral vector-based COVID-19 vaccine.

J Thromb Haemost 2021 Apr 20. Epub 2021 Apr 20.

Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.

We describe the first Danish case of presumed inflammatory and thrombotic response to vaccination with an adenoviral (ChAdOx1) vector-based COVID-19 vaccine (AZD1222). The case describes a 60-year-old woman who was admitted with intractable abdominal pain 7 days after receiving the vaccine. Computed tomography of the abdomen revealed bilateral adrenal hemorrhages. Read More

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Heparin-induced thrombocytopenia: construction of a pre-test diagnostic score derived from the analysis of a prospective multinational database, with internal validation.

J Thromb Haemost 2021 Apr 19. Epub 2021 Apr 19.

F-Crin INNOVTE, Université de Lyon, CIC 1408, Inserm U1059 SAINBIOSE, Saint-Etienne, France.

Background: Diagnosis of heparin-induced thrombocytopenia (HIT) requires pre-test probability assessment and dedicated laboratory assays.

Objective: To develop a pre-test score for HIT.

Design: Observational; analysis of prospectively collected data of hospitalized patients suspected with HIT (ClinicalTrials. Read More

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Comparison of Bivalirudin Versus Heparin for Maintenance Systemic Anticoagulation During Adult and Pediatric Extracorporeal Membrane Oxygenation.

Crit Care Med 2021 Apr 19. Epub 2021 Apr 19.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN.

Objectives: To provide a comparative analysis of conventional heparin- versus bivalirudin-based systemic anticoagulation in adult and pediatric patients supported on extracorporeal membrane oxygenation.

Design: Retrospective chart review study of adult and pediatric patients receiving extracorporeal membrane oxygenation from January 1, 2014, to October 1, 2019.

Setting: A large, high-volume tertiary referral adult and pediatric extracorporeal membrane oxygenation center. Read More

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Delayed Recognition of Levetiracetam-induced Pancytopenia.

Eur J Case Rep Intern Med 2021 30;8(3):002449. Epub 2021 Mar 30.

Hematology/Oncology, Rochester General Hospital, Rochester, New York, USA.

Blood dyscrasias associated with levetiracetam use can be difficult to identify, especially when other potential differential diagnoses are concurrently present. Here we present a 57-year-old man with metastatic adenocarcinoma of unknown primary origin on levetiracetam who initially presented with an in-stent thrombosis of the right external iliac vein and then developed worsening thrombocytopenia followed by pancytopenia. Levetiracetam was not identified as the culprit until other causes like platelet consumption, heparin-induced thrombocytopenia, idiopathic immune thrombocytopenic purpura, and bone marrow involvement by metastatic disease were ruled out. Read More

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Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination - A report of two UK cases.

Brain Behav Immun 2021 Apr 20. Epub 2021 Apr 20.

Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK. Electronic address:

Recent reports have highlighted rare, and sometimes fatal, cases of cerebral venous sinus thrombosis (CVST) and thrombocytopenia following the Vaxzevria vaccine. An underlying immunological mechanism similar to that of spontaneous heparin-induced thrombocytopenia (HIT) is suspected, with the identification of antibodies to platelet factor-4 (PF4), but without previous heparin exposure. This unusual mechanism has significant implications for the management approach used, which differs from usual treatment of CVST. Read More

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Comparative effectiveness and safety of anticoagulants for the treatment of heparin-induced thrombocytopenia.

Am J Hematol 2021 Apr 15. Epub 2021 Apr 15.

Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland.

Background: The effectiveness and safety of non-heparin anticoagulants for the treatment of heparin-induced thrombocytopenia (HIT) are not fully established, and the optimal treatment strategy is unknown. In a systematic review and meta-analysis, we aimed to determine precise rates of platelet recovery, new or progressive thromboembolism (TE), major bleeding, and death for all non-heparin anticoagulants and to study potential sources of variability.

Methods: Following a detailed protocol (PROSPERO: CRD42020219027), EMBASE and Medline were searched for all studies reporting clinical outcomes of patients treated with non-heparin anticoagulants (argatroban, danaparoid, fondaparinux, direct oral anticoagulants [DOAC], bivalirudin, and other hirudins) for acute HIT. Read More

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Vaccine-induced immune thrombotic thrombocytopenia (VITT): targeting pathomechanisms with Bruton tyrosine kinase inhibitors.

Thromb Haemost 2021 Apr 13. Epub 2021 Apr 13.

Ludwig-Maximilians-University, Institute for Prevention of Cardiovascular Disease, Munich, Germany.

A series of cases with rare thromboembolic incidents including cerebral sinus vein thrombosis (some of them fatal) and concomitant thrombocytopenia occurring shortly after vaccination with the COVID-19 vaccine AZD1222 (Vaxzevria) has caused significant concern and led to its temporary suspension in many countries. Immediate laboratory efforts in four of these patients have identified a tentative pathomechanism underlying this syndrome termed vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) or vaccine-induced thrombosis with thrombocytopenia (VITT), which encompasses the presence of platelet-activating antibodies to platelet-factor 4/heparin complexes, possibly emulated by polyanionic constituents of AZD1222, and thus resembles heparin-induced thrombocytopenia (HIT). Because these immune complexes bind and activate platelets via Fcγ-receptor IIA (FcγRIIA), high-dose intravenous immunoglobulin G has been suggested for treatment of VIPIT in addition to non-heparin anticoagulants. Read More

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Antiplatelet and anticoagulation strategies for left ventricular assist devices.

Ann Transl Med 2021 Mar;9(6):521

Division of Cardiovascular Diseases, University of Arizona, Tucson, AZ, USA.

Left ventricular assist devices (LVAD) have revolutionized the management of advanced heart failure. However, complications rates remain high, among which hemorrhagic and thrombotic complications are the most important. Antiplatelet and anticoagulation strategies form a cornerstone of LVAD management and may directly affect LVAD complications. Read More

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Bleeding and Thrombotic Adverse Events in Hospitalized Patients Under Empiric Treatment for Suspected Heparin-Induced Thrombocytopenia While Awaiting Confirmatory Testing.

Clin Appl Thromb Hemost 2021 Jan-Dec;27:1076029621996473

Hematology, 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Empiric management in suspected heparin-induced thrombocytopenia (HIT) is challenging due to imperfect prediction models, latency while awaiting test results and risks of empiric therapies. When there is high clinical suspicion for HIT, cessation of heparin and empiric non-heparin anticoagulation with FDA-approved argatroban is recommended. Alternatively off-label fondaparinux or watchful waiting have been utilized in clinical practice. Read More

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Bivalirudin as a Systemic Anticoagulant and Flush Solution Additive for Sequential Mitral and Tricuspid Valve Percutaneous Edge-to-Edge Repair in a Patient With Heparin-Induced Thrombocytopenia.

J Cardiothorac Vasc Anesth 2021 Mar 6. Epub 2021 Mar 6.

Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; University of Alabama at Birmingham Comprehensive Cardiovascular Center, Birmingham, AL. Electronic address:

Herein the case of a patient with a prior history of heparin-induced thrombocytopenia who underwent percutaneous mitral valve edge-to-edge repair that was followed by a tricuspid edge-to-edge repair two months later is presented. Recommendations exist for systemic anticoagulant alternatives for percutaneous mitral valve edge-to-edge repair with the MitraClip device (Abbott, Chicago, IL), but minimal guidance and experience are present regarding alternative systemic anticoagulation during the performance of right-sided interventions, including tricuspid edge-to-edge repair (TriClip; Abbott). Notably, there is no clear consensus regarding the use of an alternative anticoagulant in the catheter flush solution for the delivery systems used during these procedures, particularly for right-sided interventions. Read More

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Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination.

N Engl J Med 2021 Apr 9. Epub 2021 Apr 9.

From Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald (A.G., T.T.), and the Division of Safety of Medicinal Products and Medical Devices, Paul-Ehrlich-Institut (Federal Institute for Vaccines and Biomedicines), Langen (K.W.) - both in Germany; the Departments of Pathology and Molecular Medicine and of Medicine, McMaster University, Hamilton, ON, Canada (T.E.W.); and the Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna (P.A.K., S.E.).

Background: Several cases of unusual thrombotic events and thrombocytopenia have developed after vaccination with the recombinant adenoviral vector encoding the spike protein antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (ChAdOx1 nCov-19, AstraZeneca). More data were needed on the pathogenesis of this unusual clotting disorder.

Methods: We assessed the clinical and laboratory features of 11 patients in Germany and Austria in whom thrombosis or thrombocytopenia had developed after vaccination with ChAdOx1 nCov-19. Read More

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Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination.

N Engl J Med 2021 Apr 9. Epub 2021 Apr 9.

From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.

We report findings in five patients who presented with venous thrombosis and thrombocytopenia 7 to 10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against coronavirus disease 2019 (Covid-19). The patients were health care workers who were 32 to 54 years of age. All the patients had high levels of antibodies to platelet factor 4-polyanion complexes; however, they had had no previous exposure to heparin. Read More

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Diagnosis and Management of Vaccine-Related Thrombosis following AstraZeneca COVID-19 Vaccination: Guidance Statement from the GTH.

Hamostaseologie 2021 Apr 1. Epub 2021 Apr 1.

Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany.

The COVID-19 pandemic is an ongoing global healthcare crisis. Based on reports of atypically located thromboses following vaccination with the AstraZeneca COVID-19 vaccine, the Society of Thrombosis and Haemostasis Research (GTH) has issued guidance statements on the recognition, diagnosis, and treatment of this rare complication. It shares pathophysiological features with heparin-induced thrombocytopenia (HIT) and is referred to as vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). Read More

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