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Studies that included NOACs and warfarin have shown that timing a procedure further out from NOAC dosing, the use of atraumatic techniques, and employing local hemostatic measures resulted in minimal adverse outcomes

This is probably due to another aspect of IGF-1 its binding proteins

Plessis SS, Page C, Franken DR (2002) Extracellular signal-regulated kinase activation involved in human sperm-zona pellucida binding

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