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Months 4 through 6 and Beyond: Maintenance and Refinement For patients who continue a structured protocol, the second quarter of treatment often brings refinement rather than dramatic loss

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In response to increased plasma Hcy concentrations, there may be vascular endothelial dysfunction, reduced expression of thrombomodulin and activated protein C [64], a decrease in the presence of anticoagulant heparans [65], and a decrease in tissue plasminogen activator receptors on the surface of vascular endothelial cells [66]

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