1. Rivaroxaban compared with enoxaparin for the prevention of venous thromboembolism in acutely ill medical patients
Alexander T Cohen
On behalf of the MAGELLAN Steering Committee and Investigators

2. Potential conflicts
Dr AT Cohen is a medical consultant, and has received honoraria, consultancy and clinical trial funding from many pharmaceutical companies, including:
Astellas, AstraZeneca, Bayer, Boheringer-Ingelheim, BMS, Daiichi Sankyo, GSK, Johnson and Johnson, Mitsubishi Pharma, Pfizer, Sanofi-Aventis, Schering Plough, and Takeda
He is an advisor to the UK Government Health Select Committee, the all-party working group on thrombosis, the Department of Health, and the NHS, on the prevention of VTE
He is also an advisor to Lifeblood: the thrombosis charity and is the founder of the European educational charity the Coalition to Prevent Venous Thromboembolism
Presentation includes discussion of the following off-label use of a drug or medical device: No Rivaroxaban is not currently approved for use in the United States

3. Attributable risk for DVT/PE
Thrombosis background
Attributable risk for DVT/PE
Risk factor
Attributable risk (%)
(95% CI)
Hospitalization with surgery
23.8
(20.3–27.3)
Hospitalization without surgery
21.5
(17.3–25.6)
Malignant neoplasm
18.0
(13.4–22.6)
CHF
9.5
(3.3–15.8)
Neurological disease with extremity paresis
6.9
(3.5–10.2)
Medical patients
Attributable risk for DVT/PE
Heit et al. assessed the incidence of venous thromboembolism by estimating the population attributable risk (defined as the percentage of all cases of a disease in a population that can be ‘attributed’ to a risk factor) for deep vein thrombosis and pulmonary embolism associated with venous thromboembolism risk factors.
Methods: population-based, nested, case-control study of 625 residents of Olmsted County, Minnesota, with a definite first lifetime DVT or PE diagnosed and 625 unaffected residents of Olmsted County matched for age and sex.
Results: Fifty-nine percent of the cases of venous thromboembolism in the community could be attributed to institutionalization (current or recent hospitalization or nursing home residence).
Hospitalization for surgery (24%) and for medical illness (22%) accounted for a similar proportion of the cases, while nursing home residence accounted for 13%.
Abbreviation
CI, confidence interval
Reference
Heit et al. Arch Intern Med 2002;162:1245–1248
Heit et al, 2002 3 3 3

4. Contemporary studies of hospitalized patients
Short-term thromboprophylaxis
Primary efficacy endpoint* (%)
Major bleeding (%)
MEDENOX (1999)1
Placebo
14.9
1.1
Enoxaparin 40 mg od
5.5
1.7
PREVENT (2004)2
5.0
0.2
Dalteparin
2.8
0.5
ARTEMIS (2006)3
10.5
Fondaparinux
5.6
Extended thromboprophylaxis
EXCLAIM (2010)4
Placebo (after open-label enoxaparin run-in)
4.0
0.3
Extended enoxaparin
2.5
0.8
MEDENOX, all VTE between day 1 and 14; PREVENT, asymptomatic proximal DVT, symptomatic VTE, and sudden death up to day 21; ARTEMIS, all VTE up to day 15; EXCLAIM, all VTE up to day 28
1. Samama et al, 1999; 2. Leizorovicz et al, 2004; 3. Cohen et al, 2006; 4. Hull et al, 2010 4

5. Background and study questions
Thrombosis background
Background and study questions
Background
The optimal duration of thromboprophylaxis (short or extended) and the acutely ill patient population most likely to benefit from extended thromboprophylaxis is not well characterized
Study question
Is 10 days of anticoagulation with rivaroxaban non-inferior to enoxaparin?
Is 35 days of anticoagulation with rivaroxaban superior to enoxaparin followed by placebo?
Cohen et al, 2011 5 5 5

6. MAGELLAN: clinical trial design
Thrombosis background
MAGELLAN: clinical trial design
8,101 patients randomized
Day 10 (6–14)
Day 35 (31–39)
Day 90 (83–97)
Oral rivaroxaban 10 mg od 35±4 days
Patients ≥40 years hospitalized for acute medical illness with decreased level of mobility
s.c. placebo 10±4 days
Follow-up period to Day 90 R
Oral placebo 35±4 days
s.c. enoxaparin 40 mg od 10±4 days
Clinical development of new agents: MAGELLAN (continued)
8,000 patients are expected to be enrolled
Patients randomized to oral rivaroxaban 10 mg od for 31–39 days or s.c. enoxaparin 40 mg od for 6–14 days
The primary outcome is the composite of VTE and death up to day 35
The secondary outcome measures are the individual components of the composite endpoint (VTE and death) and other cardiovascular events up to 97 days
The study is expected to be completed in July 2010
Abbreviation
s.c. subcutaneous
Reference
clinicaltrials.gov. Information for MAGELLAN.
Cohen et al, poster presented at EHA Abstract 2189
Ultrasonography on day 10±4
Ultrasonography on day 35±4
Primary efficacy outcome (non-inferiority)
Primary efficacy outcome (superiority)
Cohen et al, 2011 6 6

7. MAGELLAN: study outcomes
Thrombosis background
MAGELLAN: study outcomes
Primary efficacy outcome
Composite of:
Asymptomatic proximal DVT detected by mandatory ultrasonography
Symptomatic DVT (proximal or distal)
Symptomatic non-fatal PE
VTE-related death
At Day 10 (test for non-inferiority)
At Day 35 (test for superiority)
Main safety outcome
Composite of major bleeding and non-major clinically relevant bleeding observed not later than 2 days after the last intake of double-blind study medication (treatment-emergent)
Reference
Cohen et al, poster presented at EHA Abstract 2189
Cohen et al, 2011 7 7

8. Sample size and assumptions
Sample size: 2,876 valid patients per group was estimated to obtain a joint power of at least 90%
Non-inferiority: Day 10
Assumptions: 2.2% event rate in control group; 1.4% event rate in the rivaroxaban group; 35% RRR
Non-inferiority margin: 1.5
Superiority: Day 35
Assumptions: 4.0% event rate in the control group; 2.4% event rate in the rivaroxaban group; 40% RRR
Cohen et al, 2011 8

9. Patient flow: Day 10 and 35 endpoints
Thrombosis background
Patient flow: Day 10 and 35 endpoints
Rivaroxaban
Enoxaparin/placebo
Randomized (n=8,101)
4,050
4,051
Safety
3,997 (99%)
4,001 (99%)
Modified intent to treat
Day 10
3,232 (80%)
3,271 (81%)
Day 35
2,967 (73%)
3,057 (75%)
Preliminary data (source:Topline Results Table 14.1/17: page 5)
2,938 (73%)
Per-protocol
Day 10
2,993 (74%)
Day 35
2,516 (62%)
2,586 (64%) 9 9 9 9 9

10. Patient characteristics*
Thrombosis background
Patient characteristics*
Rivaroxaban (N=3,997)
Enoxaparin/placebo (N=4,001)
Age, median (years)
71.0
Male (%)
55.6
52.6
Weight, mean (kg)
77.5
77.3
Body mass index, mean (kg/m2)
28.2
Median duration of hospitalization (d)
11.0
Creatinine clearance (%)†
<30 ml/min 2
30-<50 20
50-<80 ml/min 37 38
≥80 ml/min 39
Race (%)†
White 69
Asian
Other 7
Preliminary data (source:Topline Results Table 14.1/24/44 & 14.2/254 pages 7, 8, 12, 40); CSR 12839, 27 Jan 2011, Table 14.2/45, page 115)
Page 330 – safety for hospital
Ref. Table 14 / 8: Page 368
* Safety population; †some data missing 10 10 10 10 10

11. Underlying medical conditions*
Thrombosis background
Underlying medical conditions*
Acute medical conditions
Rivaroxaban (N=3,997)
Enoxaparin/placebo (N=4,001) %
Heart failure 32 33
Active cancer 7
Acute ischemic stroke 17
Acute infectious diseases 46 45
Acute inflammatory/rheumatic diseases 4
Acute respiratory insufficiency 27 29
Other medical conditions 1
≥2 underlying medical conditions 31
Preliminary data (source:Topline Results Table 14.1/24/44 & 14.2/254 pages 7, 8, 12, 40)
Ref. Table 14 / 15: Page 435
* Safety population 11 11 11 11 11

12. Primary efficacy outcome: Day 10*
Thrombosis background
Primary efficacy outcome: Day 10*
Rivaroxaban (n=2,939)
Enoxaparin (n=2,993) n %
Primary efficacy outcome 78
2.7 82
Asymptomatic proximal DVT 71
2.4
Symptomatic lower extremity DVT 7
0.2 6
Symptomatic non-fatal PE 2
<0.1
VTE-related death‡ 3
0.1
0.713
0.968
1.334
Preliminary data (source:
Ref: Table 29, p 564/1293, and Table 34, p569/1293
p= for non-inferiority (one-sided)
1.00
1.50
Relative risk ratio
Superior
Non-inferior
Inferior
* PP population, events up to Day days; ‡includes cases where PE cannot be ruled out 12 12 12 12 12 12

13. Primary efficacy outcome: Day 35*
Thrombosis background
Primary efficacy outcome: Day 35*
Rivaroxaban (n=2,967)
Enoxaparin/placebo (n=3,057) n %
Primary efficacy outcome
131
4.4
175
5.7
Asymptomatic proximal DVT
103
3.5
133
Symptomatic lower extremity DVT 13
0.4 15
0.5
Symptomatic non-fatal PE 10
0.3 14
VTE-related death† 19
0.6 30
1.0
0.618
0.771
0.962
ARR 1.3%, RRR 22.9%
Preliminary data (source:
p= for superiority (two-sided)
1.00
Relative risk ratio
Superior
Non-inferior
Inferior
*mITT population, events up to Day days; †4 confirmed fatal PEs 13 13 13 13 13 13 13

14. Principal safety outcome
Rivaroxaban (n=3,997)
Enoxaparin/ placebo (n=4,001) RR
p value
Day 10
Clinically relevant bleeding (major + non-major clinically relevant bleeding)
111 (2.8%)
49 (1.2%)
2.3
<0.0001
Major bleeding
24 (0.6%)
11 (0.3%)
2.2
0.0318
Fatal
5 (0.1%)
1 (<0.1%)
5.0
0.1415
Day 35
164 (4.1%)
67 (1.7%)
2.5
43 (1.1%)
15 (0.4%)
2.9
0.0004
7 (0.2%)
7.0
0.0687
Day 10 (Table /5)
Day 35 (Table /5)
Safety population; Treatment-emergent bleeding

15. Enoxaparin/placebo (N=4,001)
Other outcomes: Day 35
Rivaroxaban (N=3,997)
Enoxaparin/placebo (N=4,001)
Outcome %
Net clinical benefit*
9.4
7.8
Any cardiovascular event
1.8
1.6
All-cause mortality
5.1
4.8
Liver function ALT >3 x ULN + bilirubin >2 x ULN**
0.2
CV table: 14_ page 148
*The composite of asymptomatic proximal DVT, symptomatic DVT, symptomatic non-fatal PE, VTE-related death, treatment-emergent major bleeding, and non-major clinically relevant bleeding Modified-intention-to-treat population; **day 90+7 data

16. Pre-specified regions: Day 35 net clinical benefit
Western Europe
North/South America
Riva %
Enox/PBO %
RR (95% CI)
Enox/PBO %
Primary efficacy
3.5
7.1
0.5 (0.32–0.78)
4.5
5.1
0.9 (0.56–1.55)
Major bleeding
0.8
0.5
1.7 (0.61–4.57)
1.3
0.1
10.2 (1.31–79.53)
Net clinical benefit*
4.8
7.7
0.6 (0.42–0.93)
6.3
5.2
1.2 (0.75–1.92)
Eastern Europe
Asia/Africa
Primary efficacy
5.3
0.9 (0.61–1.31)
4.7
0.9 (0.55–1.40)
Major bleeding
0.9
0.3
2.7 (0.87–8.54)
1.4
3.0 (0.97–9.24)
Net clinical benefit*
5.7
1.0 (0.70–1.43)
5.9
1.1 (0.70–1.63)
Tables 14.2/115, /166, /55
*Composite of asymptomatic proximal DVT, symptomatic DVT, symptomatic non-fatal PE, VTE-related death and treatment-emergent major bleeding 16 16 16

17. Contemporary studies of hospitalized patients
Short-term thromboprophylaxis
Primary efficacy endpoint* (%)
Major bleeding (%)
MEDENOX (1999)1
Placebo
14.9
1.1
Enoxaparin 40 mg od
5.5
1.7
Extended thromboprophylaxis
EXCLAIM (2010)4
Placebo (after open-label enoxaparin run-in)
4.0
0.3
Extended enoxaparin
2.5
0.8
MAGELLAN
Enoxaparin/placebo
5.7
0.4
Extended rivaroxaban
4.4
MEDENOX, all VTE between day 1 and 14; PREVENT, asymptomatic proximal DVT, symptomatic VTE, and sudden death up to day 21; ARTEMIS, all VTE up to day 15; EXCLAIM, all VTE up to day 28; MAGELLAN, asymptomatic proximal DVT, symptomatic VTE and VTE-related death up to day 35
1. Samama et al, 1999; 2. Leizorovicz et al, 2004; 3. Cohen et al, 2006; 4. Hull et al, 2010 17

18. Summary MAGELLAN met its primary efficacy endpoints
Day 10: rivaroxaban was non-inferior to enoxaparin in reducing the risk of VTE
Day 35: extended thromboprophylaxis was superior to enoxaparin followed by placebo in reducing the risk of VTE
Overall bleeding rates were low, but significantly higher in the rivaroxaban arm across the entire study period
Rates of other adverse events, including liver and cardiovascular events, were similar in both arms 18

19. Conclusion
MAGELLAN confirms that there is a continued risk of VTE beyond the period of hospitalization or immobilization in acutely ill patients
The risk of bleeding must be weighed against the benefit of preventing DVT and PE events in deciding which patients to treat
Further analysis is required to identify which group of patients studied in the MAGELLAN trial may benefit from extended thromboprophylaxis with rivaroxaban 19

20. Acknowledgements
Steering Committee: Alexander Cohen MBBS Chairman; Harry Büller MD PhD; Alexander Mebazaa MD PhD; Sebastian Schellong MD; Geno Merli MD; Victor Tapson MD; Russell Hull MBBS; Dayi Hu MD PhD; Lloyd Haskell MD; Theodore Spiro MD; Data Safety and Monitoring Board: Alain Leizorovicz MD Chairman; Gordon Lowe MD; Charles Francis MD; Robin Roberts MT; Shotai Kobayashi MD PhD
Bayer: Global Clinical Leader, Theodore Spiro MD; Medical Experts:  Eva Mühlhofer MD & Melanie Hemmrich MD; Statistician: Dr. Horst Beckmann; Study Managers: Andrea Duszczyszyn, Lynda Fielding, Teresa Twomey; Study Data Manager: Karin Müller; Johnson & Johnson: Physicians: Lloyd Haskell MD
Countries and individual sites: Argentina (7 sites); Australia (11 sites); Austria (14 sites); Belgium (10 sites); Brazil (8 sites); Bulgaria (8 sites); Canada (13 sites); Chile (2 sites); China (43 sites); Colombia (8 sites); Croatia (6 sites); Czech Republic (7 sites); Denmark (5 sites); Estonia (4 sites); Finland (2 sites); France (22 sites); Germany (27 sites); Greece (10 sites); Hong Kong (2 sites); Hungary (8 sites); India (14 sites); Indonesia (3 sites); Israel (10 sites); Italy (21 sites); Japan (32 sites); Korea (7 sites); Latvia (6 sites); Lithuania (10 sites); Luxembourg (2 sites); Malaysia (3 sites); Mexico (12 sites); The Netherlands (4 sites); New Zealand (3 sites); Norway (4 sites); Pakistan (3 sites); Peru (7 sites); Poland (14 sites); Portugal (10 sites); Russia (8 sites); Singapore (6 sites); Slovakia (5 sites); Slovenia (6 sites); South Africa (14 sites); Spain (11 sites); Sweden (9 sites); Switzerland (6 sites); Taiwan (5 sites); Thailand (3 sites); Turkey (6 sites); Ukraine (16 sites); UK (7 sites); US (72 sites)

21. Acknowledgements
INVESTIGATORS: MR. DR. FEDERICO BOTTAROMR. DR. HECTOR HENDLERMRS. DR. BEATRIZ GRANDMRS. DR. ANALIA MYKIETIUKMR. DR. MARTIN HOJMANMR. DR. OSCAR CABERLOTTOMR. DR. RAUL SALERNO, HR. PROF. DR. ERNST PILGERPRIM. DR. NORBERT BAUERPROF. DR. PETER SIOSTRZONEKUNIV. PROF. DR. RUDOLF KIRCHMAHR. PRIM. DR. WERNER FORTUNATPRIM. DR. CHRISTOPH WENISCHPRIM. PROF. DR. ANSGAR WELTERMPRIM. DOZ. DR. LUDWIG ERLACHEROA DR. HANS-ROBERT SCHONHERRPRIM. DR. BERND BAUERPRIM. DR. ERWIN GRAFLUNIV. PROF. DR. FELIX KEILPRIM. PROF. DR. PETER BALCKEPRIM. PROF. DR. FRANZ WEIDINGE, PROF. HATEM SALEMDR MICHAEL LEYDENPROFESSOR BENG CHONGPROFESSOR BENG CHONGDR PATRICK CARROLLDR DAVID COLQUHOUNDR DAVID JACKSONA/PROF. ENG GANA/PROF. STEPHEN HALLDR DAVID SERISIERA/PROF ROSS BAKER, PROF. DR. DANIEL BLOCKMANSDR. KØNRAAD HENDRICKXDR. HARRY STRIEKWOLDDR. GUY VAN ROEYDR. MARIE-ELENA VANDEN ABEELEDR. CAROLINE JACQUYDR. ALAIN DELOBBEPROF. ALAIN SOUPARTDR. LUC VAN ZANDWEGHEDR. ACHIEL VAN HOOF, PROF. VALENTINA MINCHEVAPROF. STEFAN MILANOVDR. LYUBOMIR LYUBENOVDR. STOYANKA NENKOVADR. DIMO DIMOVDR. MARGARITA TASEVAPROF. YAVOR IVANOVPROF. DIMITAR POPOV, MR DR. BERNARDO GARICOCHEAMR DR CYRILLO CAVALHEIROMR DR DALTON CHAMONEMR DR JOYCE BIZZACCHIMR DR ELIE FISSMR DR ANTONIO LOPESMR. DR. BONNO BELLENMR DR. RICA RDO MOREIRA, DR. ASHFAQ SHUAIBDR. FRANCOIS DUBEDR. DEMETRIOS KUTSOGIANNISDR. STEVE VERREAULTDR. BRIAN BUCKDR. ANDRE ROUSSINDR. GARRY MODDELDR. GRANT STOTTSDR. HIREN DESAIDR. JEAN-MARTIN BOULANGERDR. FRANK SILVERDR. NICOLE DANEAULTDR. CELINE BERGERON, HR. DR. MED. MARTIN BANYAIFR. PROF. DR. IRIS BAUMGARTNERPROF. DR. MED. ALFRED SCHIFFERHR. DR. MED. ALEXANDER IMHOFFR. PD DR. MED. CHRISTINA JEANHR. DR. MED. PATRICK NUSSBAUME, MR. DR. GUILLERMO BUGEDOMR. DR. HUMBERTO TORRES, PROF. DAYI HUPROF CHEN WANGPROF YONGJUN WANGDR YUEJIN YANGPROF. YIHAN CHENDR CE SHENPROF. JIANGRONG LIUPROF SHIYAO WUPROF. WEI LIPROF ZHONGXIN ZHAODR QINGYU XIUPROF. SUI-YANG ZHANGDR TAOHONG HUPROF XIAOWEI YANDR LUYUE GAIDR YUSHENG ZHAOPROF QI HUAPROF. HONGWEI LIPROF. JIMEI LIPROF. DE PING ZHANGDR BIAO XUPROF. QI WANPROF. RONGCHANG CHENPROF SHAOXIANG XIANDR YAN LIUPROF QINGCHUN GAODR CHUNTAO LIUDR GUOXIAN QIPROF. PING CHENPROF. SHENGHUA SUNPROF KAN YANGDR CHANGGUI WUPROF HAICHANG WANGPROF. LAN YANGPROF XINYUE QINDR. SHULIANG GUOPROF YINGXIAN SUNDR YANNI WANGDR YAN-SHENG LIPROF YUJIE ZHOUDR KANG-NING CHENDR JIANG WUDR. JIAN ZHANG, MR. DR. DIEGO FAJARDOMR. DR. RODRIGO BOTEROMR. DR. ROBIN RADAMR. DR. LUIS GOMEZMR. DR. LUIS URIBEMR. DR. JORGE CEDANOMR. DR. JUAN VELASQUEZMR. DR. CARLOS JARAMILLO, PROF. ALES LINHARTDR. OTTO MAYERDR KAREL GORICANDR VLASTIMIL PROCHAZKADR. JAN FIKSADR. IGOR MACELDR JAN SEDLACEK, HR. PROF. DR. WOLFGANG PETERMAHR. PROF. DR. BERND MUHLBAUERHR. PD DR. JURGEN BARTHHR. DR. HOLGER LAWALLHR. PROF. DR. CHRISTOPH POHLHR. PROF. DR. THEODOR KLOTZHR. PROF. DR. J.-D. RINGEHR. PROF. DR. JAN SCHMIDT-LUCKHR. PD DR. TOBIAS HEINTGESFR. DR. IRINA SCHOFFAUERHR. PD DR. ARNO DORMANNHR. DR. WINFRED THEELENHR. DR. FRANK-M. DROUVENHR. PROF. DR. CLAUS NIEDERAUHR. PROF. DR. BERND SANNERHR. DR. HANS-RUDOLF MILSTREYHR. PD DR. MATHIAS BORSTHR. PROF. DR. JURGEN VOM DAHLFR. DR. HEIDRUN HINDAHLHR. PD DR. ERICH STØLBENHR. PROF. DR. SEBASTIAN SCHELLHR. DR. JAN BEYER-WESTENDORFHR. PD DR. ROLAND VELTKAMPHR. PROF. DR. SVEN MOBIUS-WINKFR. PROF. DR. CHRISTINE ESPINOHR. PROF. DR. MATTHIAS LESCHKEFR. PROF. DR. INGE SCHARRER, DR HENRIK NIELSENDR. SØREN AVNSTRØMDR CHRISTIAN TUXENDR. TONNY NIELSENDR OVE ØSTERGAARD, DR TIINA UUETOADR TOOMAS MARANDIDR MARGUS LEMBERDR OLGA KOLBASSOVA, DR. MANUEL MONREALDR. ANTONI CASTRODR. CARLES TOLOSADR. FRANCISCO CONGETDR. JOSE-ANTONIO NIETO RODRIGUDR. RAIMUNDO TIRADO MIRANDADRA. MARIA GUILDR. JOSEP BISBEDR. FERNANDO CERETO CASTRODR. JAVIER TRUJILLO SANTOSDR. JAUME VILLALTA, DR RIITTA LASSILADR. JUHANI KARMAKOSKI, PROFESSEUR PATRICK MISMETTIPR DOMINIQUE MOTTIERPR JEANNOT SCHMIDTPROFESSEUR ISABELLE QUEREPROFESSEUR CLAIRE LE JEUNNEPROFESSEUR DENIS VITAL-DURANDPR ISABELLE MAHEDOCTEUR RIADH RIHANIPROFESSEUR JEAN-FRANCOIS BERGMPR PHILIPPE DEBOURDEAUDR MARC LAMBERTPROFESSEUR DOMINIQUE STEPHANPR BERNARD LORCERIEPR PHILIPPE LACROIXDR ALAIN PROUSTPROFESSEUR DOMINIQUE FARGE-BANPR CHARLES-HUGO MARQUETTEDR DOMINIQUE BRISOTDR CLEMENT FOURNIERDR AUDREY DUCHEMINDR SANDRO AQUILANTIPR MICHEL GALINIER, DR MARIE SCULLYDR ANDER COHENDR PATRICK KESTEVENDR MARK ELLIOTTDR JOHN LUCKITDR P RAFFERTYDR RAMESH DURAIRAJ, MR. PROF. DR. HARRY BASSARISPROF. DR. ATHANASIOS SKOUTELISMR.DR. FREDERICOS VLASTOSMR. DR. MICHAIL TOUBISDR. MR. GEORGIOS PANOUTSOPOULDR. MR. STYLIANOS APSOKARDOSDR. DIMITRIOS BABALISDR., MRS. ANASTASIA KARAFOULIDDR. APOSTOLOS KATSIVASDR. SOTIRIOS PATSILINAKOS, PROF LAWRENCE K. S. WONGDR RAYMOND S.M. WONG, PROF. MIJO BERGOVECPROF. MIROSLAV SAMARZIJADR SILVA ZUPANCIC-SALEKDOC. SANJA HAJNSEKDR. ALEKSANDAR KNEZEVICDR. ROBERT STEINER, DR. JANOS NIKLDR ISTVAN KONDAKORDR GABOR NYIRATIDR. GABOR JAKABDR ZOLTAN SZAKACSDR FERENC NAGYDR NORBERT SZEGEDIDR ZSUZSANNA FRANKFURTER, DR KARMEL TAMBUNANMD, MPH HARMANI KALIMDR MOH MACHFØD, DR. DAVID ZELTSERPROF. SHMUEL ORENDR. MICHAEL LISHNERPROF. REUVEN ZIMLICHMANDR. ZEV STHØGERDR. HUSSEIN OSAMAHDR. MAZEN ELIASPROF TONY HAYEKDR. GREGORY TELMANDR. NIZAR ELIAS, DR. SHIVAKUMAR BHAIRAPPADR. ASHOKAN CHEVIRIDR. MILIND GADKARIDR. KARKAL PRADEEP KUMARDR. AJAY NAIKDR. ABRAHAM OOMMANDR. KAMESHWARAO KUCHIMANCHIDR. AJAY MAHAJANDR DEEPAK TALWARDR PURVEZ GRANTDR JAGDEEP WHIGDR . GURUPRAKASH AVVARUDR RM PL RAMANATHANDR CHERUKUPALLI RAGHU, PROF. GIANCARLO AGNELLIDR. WALTER AGENODR. MATTEO GIORGI PIERFRANCESCDR. CORRADO LODIGIANIDR. MAURO SILINGARDIDR. RENZO POGGIOPROF. SERGIO SIRAGUSADR. ENRICA MORRADR. ANGELO DE BLASIODR. GIANCARLO CASTAMANDR. ROBERTO BUZZONIDR. ANDREA FONTANELLADR. ANNA FALANGADR. RAFFAELE LANDOLFIPROF. MARIO PINIDR. EGIDIO DE GAUDENZIPROF. PASQUALE PARISEDR. MARCO BONDIDR. MAURO BERRETTINIPROF. FRANCESCO VIOLIDR. ROBERTO QUINTAVALLA, DR. SHOGO NISHIDR. KIMIAKI UTSUGISAWADR. TOSHIMASA UCHIYAMADR. YUKIHIKO MOMIYAMADR. KAZUKI FUKUIDR. ERI TANAKADR. MASAKAZU NAGAOKADR. TETSUO OZAWADR. SATORU SAKAGAMIDR. TETSURO TSUJIDR. NORIKAZU YAMADADR. OSAMU HATAJIDR. ATSUYUKI WADADR. TSUTOMU ICHINOSEDR. JUNICHI FUNADADR. YOICHI NAKAMURADR. SHINICHI ANDODR. KAZUTERU FUJIMOTODR. SUSUMU MEKARUDR. KOICHI OSHIRODR. YOSHIKI SHIOHIRADR. OSAMU OKAZAKIDR. ATSUYA SHIMIZUDR. MASAYUKI KATODR. HIDENORI IBATADR. SHU IMAIDR. HIROYUKI IKEFUJIDR. TAKEFUMI SAITODR. KIMIHIKO ITODR. TADASHI MIODR. HISANORI KANIDR. HIDEMITSU NAKAGAWA, DR DONG-WHA KANGDR CHIN-SANG CHUNGDR BYUNG-WOO YOONDR YONG-SEOK LEEDR DO YEUNOHDR SOO-MEE BANGDR YEO-KYEOUNG KIM, DR BIRUTE ALEKNIENEDR ZITA BUTKIENEDR REGINA PETRAUSKIENEASS. PROF. ALFREDAS BAGDONASDR. GINTAUTAS GUMBREVICIUSDR ALGIRDAS VITKAUSKASDR VIDA BASIJOKIENEDR SIGITAS STONKUSDR VIOLETA GRISKEVICIENEDR RITA NORVILIENE, DR. PHILIPPE MULLERDR. STEFAN RAUH, DR ULDIS KUPCSDR VIESTURS ROZITISDR INGA STUKENADR. DAINIS KRIEVINSDR NATALIJA PONTAGADR ILZE AIZSILNIECE, MR. DR. ROBERTO PEREA SANCHEZMR. DR. JAIME GONZALEZ GARZAMR. DR. MARTIN GOMEZ LARAMR. DR. JORGE CARDOZA AMADORMR. DR. ALFREDO TANAKA CHAVEZMR. DR. VICTOR VELASCO RODRIGUMR. DR. FELIPE NARES OCHOAMR. DR. MIGUEL VAZQUEZ LOPEZMR. DR. CUAUHTEMOC ROMERO LOPEMR. DR. JOSE GALLEGOS MARTINEZMR. DR. DAVID HERNANDEZ GAETAMRS. DR. MARIA HERVER CABRERA, DR SZE PIAW CHINDR KUI HAN SIMDR BIN WAN AHMAD WAN AZMAN, DR. R. FIJNHEERDHR. DR. H. CATEDHR.DR. A. DEESDHR. A.M. KREUK, DR ROALD TORPDR INGVAR STOKSTADDR FREDRIK SCHJESVOLDDR WALEED GHANIMA, DR SHARON JACKSONDR DAVID SIMPSONDR PAUL OCKELFORD, MRS. DR. ROSA COTRINAMS. DR. MARCIA SALAS PEREZMR. DR. VICTOR ULLOA PEREZMRS. DR. ZANDRA MONCADA VILELAMR. DR. FERNANDO ARRIETA DIASMR. DR. ORESTES SALAZAR CANDIOMR. DR. REYNALDO CASTILLO LEON, DR. ZEBA AZIZDR. GHIAS UN NABI TAYYABDR./MR. NADEEM RIZVI, MR. PROF. ANDRZEJ SZCZEKLIKPROF. LECH WALASEKDR MONIKA BOJARSKA-LOSPROF. TOMASZ PASIERSKIDR MALGORZATA GUTOWSKA-JABLONSDR WALDEMAR KRYSIAKDR TADEUSZ ZECHOWICZMS.PROF. KARINA JAHNZ-ROZYKDR EWA MIREK-BRYNIARSKAPROF. MARIA GORSKADR MALGORZATA BIEDRZYCKADOC. ALEKSANDER GOCHDR MICHAL OGOREKDR ANTONI SYDORDR KAZIMIERZ WRZESINSKI, DR. FAUSTINO FERREIRAPROF. DR. LUIS PROVIDENCIADR. ALFREDO MARTINSDR. FERNANDO GOMESPROF. DR. FERNANDO SANTOSPROF. DR. PAULO BETTENCOURTPROF. DR. JOSE DUCLA SOARESDR. ALBERTO MELLO E SILVADR. TERESA RODRIGUESDR. AVELINO FERREIRA, DR SVETLANA KHATKOVADR ALEXANDER SOTNIKOVPROF. TATIANA FEDOROVAPROF. GRIGORY AROUTYNOVPROF. MARIA GLEZERPROF. VALENTIN MOISEEVDR. NATALIYA SHILKINADR. OLGA ERSHOVA, DR PETER SVENSSONDR INGEMAR TORSTENSSONDR ANDERS SJAELANDERDR JAN OSTERGRENDR INGAR TIMBERGDR ANN-CHARLOTTE LASKADR. PG WIKLUNDDR ERIC BERTHOLDSDR MAGDALENA CWIKIEL, DR THUN HOW ONGDR RU TANDR ALAN NGDR GERALD CHUADR HWA WOOI GANPROF ONG TENG TANG, MR. DR. MATJAZ JEREBDOC BOJANA ZVANDOC MATJAZ FLEZARDR GREGOR TRATARDR. MIHAEL SOKDR VOJKA GORJUP, DR. LUDOVIT GASPARDR. JAN STEVLIKDR. VLADIMIR SPISAKDR. FRANTISEK KOVARDR. MIROSLAV SZENTIVANYI, ASSOC. PROF. CHAIRAT PERMPIKULCOL.,MD. ANAN WATTANATHUMDR. CHAICHARN POTHIRAT, PROF. SERDAR KUCUKOGLUPROF. BARIS ILERIGELEN, PROF. ERDEM GOKERPROF. HADIYE SIRINPROF. UGUR YILMAZPROF. SANEM NALBANTGIL, DR YEN-HUNG LINDR BIH-FANG GUODR CHIH-LU HANDR KOU-GI SHYUDR KENNETH YIN-CHING CHUANG, DR VLADIMIR SKREBKOVPROF. VITALIY SORKINPROF. YEVGENIA SVYSHCHENKOPROF. OLEKSII KORZHPROF. STEPAN GENYKPROF. LEONID VORONKOVDR. VIRA TSELUYKODR. OLEXANDR KARPENKOPROF. IGOR VAKALIUKDR. MYKOLA PEREPELIUKPROF. OLEXANDER LEGKONOGOVDR. VALENTYNA KOVALDR. ANATOLIY POLYAKOVDR. YANA GONCHAROVADR. TETIANA RYABICHENKOPROF. MYKOLA VATUTIN, DR. ALBRECHT HEYDERDR. R. MURRAYDR. PADMASHRI RASTOGIDR. MARK PLAUTZDR. ROGER YUSENDR. ROBERT LAVENDERDR. GENO MERLIDR. AMIR JAFFERDR. PURVI MEHRADR. GERHARD JOHNSONDR. PAUL MANOSDR. SCOTT KAATZDR. VENKATESH NADARDR. TED WUNDR. JOHN MASSONDR. ROBERT LERNERDR. ALLAN SEIBERTDR. ROBERT MCLAFFERTYDR. JAMES WELKERDR. PATRICK WRIGHT, JR.DR. KUMAR RAJAMANIDR. DAN SCHULLERDR. AMIT SHARMADR. JOHN SIMMONSDR. FREDERICK WHITTIERDR. JOHN WARDDR. NIZAR DABOULDR. STEPHEN CHASTAINDR. JAMES DEXTERDR. JOHN UPDEGROVEDR. WILLIAM REITERDR. STEVEN STOLTZDR. STEVEN CONRADDR. MONICA HAZELRIGGDR. THOMAS LINGDR. DAVID CHENDR. KENRIC MAYNORDR. WILLIAM FRENCHDR. DENNIS DIETRICHDR. CHARLES LAWTONDR. JEFFREY BRENSILVERDR. BARRY HELLERDR. CHARLES ALBRECHT, IIIDR. CARLOS COWLEYDR. SHARAN MAHALDR. SUZANNE ANDERSONDR. WIN TØDR. PARESH POKHARELDR. MANUEL FONTESDR. HAROLD MINKOWITZDR. MAURICIO CONCHADR. ROBERT STEINDR. MARYANN PEBERDYDR. THOMAS BIRCHDR. RICHARD LIGHTDR. GERALD SOFFDR. MICHAEL COXDR. AVERY NATHANSONDR. RICHARD FEIDR. JUAN REYESDR. MICHAL KAZIMIRDR. DAVID WILLIAMSDR. TOMASZ ZIEDALSKIDR. GORDON HILL, JR.DR. JOHN SUENDR. CHARLES GREENBERGDR. PARAG MEHTADR. KENNETH WAXMANDR. WILLIAM PATTONDR. ANTHONY COMEROTADR. CRAIG THURMDR. ENGLISH GONZALESDR. PREETHAM JETTYDR. MICHAEL BENNINGHOFFDR. MOHAMED BIDAIRDR. OFSMAN QUINTANA, DR DAVID ADLERPROF LYDIA DREOSTIDR. JOHAN ENGELBRECHTDR. CØNIE KØGELENBERGDR BERNARDO RAPOPORTDR. ANDRE ROODTDR. C SMITHDR FRANCOIS STEENKAMPDR. RITA SOMMERSDR HANNES JANSE VAN RENSBURGDR BLAINE BLOYDR HENDRIK NORTJEDR. WILLIAM RABIEDR ELANE VAN NIEUWENHUIZENDR LOUIS VAN ZYL