Long-term monitoring and treatment of venous thromboembolic disease: Recommendations of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine 2024

Martín del Pozo, M.; Martín Asenjo, M.; Franco Moreno, A.I.; Usandizaga, E.; Galeano Valle, F.

doi:10.1016/j.rceng.2024.10.004

array:22 ["pii" => "S2254887424001280" "issn" => "22548874" "doi" => "10.1016/j.rceng.2024.10.004" "estado" => "S100" "fechaPublicacion" => "2024-10-16" "aid" => "2241" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:17 [ "pii" => "S2254887424001292" "issn" => "22548874" "doi" => "10.1016/j.rceng.2024.10.005" "estado" => "S5" "fechaPublicacion" => "2024-10-16" "aid" => "2240" "copyright" => "Elsevier Ltd" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:8 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "Measles in the emergency room: the enemy is still there" "tienePdf" => "en" "tieneTextoCompleto" => 0 "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarampión en sala de urgencias: el enemigo sigue ahí" ] ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Ena" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Ena" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887424001292?idApp=WRCEE" "url" => "/22548874/unassign/S2254887424001292/v1_202410160425/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S2254887424001103" "issn" => "22548874" "doi" => "10.1016/j.rceng.2024.08.001" "estado" => "S200" "fechaPublicacion" => "2024-08-28" "aid" => "2233" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Soluble receptor for advanced glycation end-products positively correlated to kidney injury with coronary heart disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El receptor soluble para productos finales de glicación avanzada se correlacionó positivamente con la lesión renal con la enfermedad coronaria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1825 "Ancho" => 3341 "Tamanyo" => 319191 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation analysis between sRAGE and uACR in CHD patients (A), and ROC analysis of sRAGE, UMA, eGFR, SCr, UCr, Albumin and BUN with uACR ≥ 30 mg/g in CHD patients (B). Each dot represents an individual patient. BUN: blood urea nitrogen; CHD: coronary heart disease; eGFR: estimated Glomerular Filtration Rate; ROC: receiver operating characteristic; SCr: serum creatinine; sRAGE: soluble receptor for advanced glycation end products; uACR: urinary albumin to creatinine ratio; UCr: urine creatinine; UMA: urine microalbumin." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lu Chen, Xiang-Jun Zeng, Xin-Ying Guo, Jian Liu, Feng-He Du, Cai-Xia Guo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Lu" "apellidos" => "Chen" ] 1 => array:2 [ "nombre" => "Xiang-Jun" "apellidos" => "Zeng" ] 2 => array:2 [ "nombre" => "Xin-Ying" "apellidos" => "Guo" ] 3 => array:2 [ "nombre" => "Jian" "apellidos" => "Liu" ] 4 => array:2 [ "nombre" => "Feng-He" "apellidos" => "Du" ] 5 => array:2 [ "nombre" => "Cai-Xia" "apellidos" => "Guo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256524001498" "doi" => "10.1016/j.rce.2024.06.016" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256524001498?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887424001103?idApp=WRCEE" "url" => "/22548874/unassign/S2254887424001103/v1_202408280421/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "Long-term monitoring and treatment of venous thromboembolic disease: Recommendations of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine 2024" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Martín del Pozo, M. Martín Asenjo, A.I. Franco Moreno, E. Usandizaga, F. Galeano Valle" "autores" => array:5 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Martín del Pozo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Martín Asenjo" "email" => array:1 [ 0 => "miguel.martin.asenjo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "A.I." "apellidos" => "Franco Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Usandizaga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "F." "apellidos" => "Galeano Valle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Infanta Sofia, Madrid, Universidad Europea de Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Intanta Leonor, Madrid, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Medicina Interna, Clínica Privada" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General Universitaio Grergorio Marañon, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguimiento y tratamiento de la enfermedad tromboembólica venosa a largo plazo: recomendaciones del Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna 2024" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4425 "Ancho" => 2430 "Tamanyo" => 1362070 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Follow-up of venous thromboembolic disease and complications." ] ] ] "textoCompleto" => "IntroductionIn order to establish the optimal duration of anticoagulant therapy in patients with venous thromboembolic disease (VTE), a balance between the risk of recurrence and the risk of bleeding should be made. Anticoagulation in VTE is divided into three phases: a) initial treatment (0–21 days); b) primary treatment or prevention phase (21 days–3 months); and c) extended treatment or secondary prevention (from 3 months)<a class="elsevierStyleCrossRefs" href="#bib0005">1–5</a> (<a class="elsevierStyleCrossRef" href="#sec0135">Fig. 1 Supplementary material</a>).Traditionally, the duration of anticoagulant therapy was based on the etiology of VTE, considering the dichotomy: provoked VTE or unprovoked VTE. This distinction is considered to be limited, however. In this regard, the individual risk factors (RFs) of the patient should also be assessed. The RFs for VTE and the exposure time are determinants of recurrence risk over follow-up.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3,6</a> In a recent meta-analysis, the risk of recurrence in unprovoked VTE after the discontinuation of anticoagulant therapy was 10% in the first year and 25% at 5 years. In provoked VTE, the risk is dependent on the RF involved, being 3% at 5 years for major transient RFs; 5% in the first year (and 15% at 5 years) for minor transient RFs; and 15% annually for permanent RFs such as cancer.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> The anticoagulant treatment phases in VTE are shown in (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, Section 1: study of the presence of risk factors).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The International Society of Thrombosis and Haemostasis suggests maintaining long-term anticoagulant therapy when the estimated risk of recurrence is greater than 5% in the first year (or 15% at 5 years).<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Anticoagulant therapy reduces the risk of recurrence during its administration, and treatment discontinuation is associated with an increased risk of thrombosis, which is higher in the first 6 months. Anticoagulation is also associated with an increased bleeding risk. In addition, the mortality associated with bleeding during anticoagulation is 2–3 times higher than that associated with the risk of recurrence.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>The main clinical practice guides recommend a minimum of three months of anticoagulant treatment for all patients with VTE. The duration of anticoagulant treatment should subsequently be established based on the risk of bleeding and the risk of recurrence, and the patient preferences moreover should be incorporated into the decision-making process. This balance is dynamic and can be modified during patient follow-up. We know that treatment with direct oral anticoagulants (DOACs) is associated with a reduced risk of bleeding, which has modified the risk-benefit profile associated with extended therapy.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3,6–10</a>The purpose of this document is to provide an update on the main guidelines for the long-term management of VTE.Material and methodsTo prepare this document, a group was formed with the main function of reviewing and synthesizing the available evidence and formulating conclusions and recommendations. A literature search was made in the PubMed, Cochrane, and Scopus (Web of Science) databases, including clinical practice guides, original articles, reviews (systematic or narrative), and meta-analyses in order to identify the most relevant evidence in accordance with the objective of this consensus document.This document consists of four parts: the first part includes the RFs of recurrence in unprovoked VTE and the predictive scales of recurrence; the second part describes the predictors of bleeding; the third part focuses on the recommendations in the long-term follow-up of VTE, addressing specific considerations for screening chronic thromboembolic pulmonary hypertension (CTEPH) and post-thrombotic syndrome (PTS); and the fourth part includes recommendations on the duration of extended anticoagulant treatment, as well as on the type of therapy and its dose.The group developing the recommendations drafted the manuscript, which underwent successive reviews by this same group. Finally, the document was reviewed by a committee of experts, members of the Working Group on Venous Thromboembolic Disease of the Spanish Society of Internal Medicine (Sociedad Española de Medicina Interna [SEMI]), and an external reviewer, until its final approval.Results and recommendationsRisk factors for recurrence in unprovoked VTE1. Presentation of the eventFor many years, the risk of recurrence associated with proximal deep vein thrombosis (DVT) and pulmonary embolism (PE) was considered to be similar and greater than the risk of recurrence following distal DVT. The meta-analysis of the MARVELOUS study analyzed recurrence after treatment discontinuation in unprovoked VTE over 10 years. The risk of recurrence in distal DVT was found to be significantly lower than in proximal DVT (95%CI relative risk [RR] 0.2 [0.05–0.7]). The risk of recurrence in proximal DVT was higher than in PE (95%CI RR 1.4 [1.1–1.7]).<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Pulmonary embolism is three times more likely to recur as PE than as DVT, whereas DVT recurs more often as DVT. The type of VTE is an important factor in deciding the duration of treatment, since recurrence as PE results in greater mortality.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a>2. D-dimerD-dimer (DD) measured approximately one month after anticoagulation discontinuation is a predictor of recurrence.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> The DD levels are higher in women than in men and increase with age, so the cut-off point should be adjusted in patients over 50 years of age, multiplying age by 10. Comorbidities increase the DD levels, because a proinflammatory state is generated. In cancer, DD increases and has a lower negative predictive value.<a class="elsevierStyleCrossRefs" href="#bib0065">13–18</a>Several meta-analyses have shown that increased DD is related to a 2.2–2.5-fold increase in the risk of unprovoked VTE recurrence.<a class="elsevierStyleCrossRefs" href="#bib0070">14–16</a> The DULCIS study assessed the relationship between DD levels at regular measurements during the first three months after the discontinuation of anticoagulant therapy and the development of VTE recurrence over two years of follow-up. The risk of recurrence in untreated patients with positive DD versus those with negative DD was three times higher (95%CI hazard ratio [HR] 2.92 [1.87–9.72]), thus suggesting the reintroduction of anticoagulation in patients with positive DD.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Kearon et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> reported a higher risk of recurrence in unprovoked VTE and negative DD in men than in women (9.7 vs 5.4 recurrences/100 patients/year). Based on these results, the authors recommend maintaining anticoagulation indefinitely in men with negative DD. These results have not been validated, however.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>D-dimer has been associated with the risk of recurrence in patients with VTE provoked by a minor RF, and some authors suggest the maintenance of anticoagulant therapy in patients with positive DD.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a>Patients treated with DOACs have higher DD levels than those treated with dicoumarins, though they do not experience more recurrences.<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a>The APIDULCIS study recently questioned the value of DD as a predictor of recurrence in unprovoked VTE. Serial DD measurements were made in an unprovoked VTE cohort; patients with positive DD over follow-up were treated with apixaban, and those with negative DD were not anticoagulated. The patients with negative DD had an increased risk of thrombotic complications (95%CI HR 8.2 [3.2–25.3]) compared with the DD-positive patients treated with apixaban. Based on these data, the authors suggested that all patients with unprovoked VTE should be maintained on low-dose apixaban.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>3. ObesityThe impact of obesity on the risk of recurrence has not been well established. Eichinger et al. reported a 60% increase in the risk of recurrence in patients with a body mass index (BMI) > 30 kg/m2 as compared to those with BMI < 30 kg/m2. However, a recent meta-analysis has found insufficient evidence to establish a relationship between obesity and the risk of recurrence.<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a>4. Inflammatory bowel diseasePatients with inflammatory bowel disease (IBD) who suffered an unprovoked VTE episode have a 2.5-fold increased risk of recurrence as compared to patients without IBD.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> In patients with IBD and clinical remission who experience an episode of unprovoked VTE, some clinical guides recommend indefinite anticoagulation. However, if VTE occurs with active disease, it is recommended that patients receive anticoagulation until the IBD activity is controlled for a minimum of three months.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a>5. ThrombophiliaThe influence of thrombophilia assessment in deciding the duration of anticoagulation is a controversial issue. The alterations most commonly related to possible recurrence must be taken into account. Forms of hereditary thrombophilia include mutation for Leiden factor V or G20210A mutation of the prothrombin gene, the deficiency of natural anticoagulants (protein C, protein S, and antithrombin), and combined deficits.<a class="elsevierStyleCrossRefs" href="#bib0130">26,27</a> Thrombophilia testing should not be performed in the acute phase, because: 1) natural anticoagulant proteins are consumed during the acute phase of thrombosis; 2) testing should be performed in the absence of anticoagulant treatment; and 3) its result will not modify the treatment decision during the first three months. In general, the presence of thrombophilia slightly increases the risk of recurrence after a first episode of VTE, and it should be interpreted as an additional factor to clinical factors, except in high-risk forms of thrombophilia. Among these, the most common is antiphospholipid syndrome (APS), which is the main cause of acquired thrombophilia (present in 9% of all VTE events), where due to the high risk of recurrence, long-term anticoagulation is recommended after a first thrombotic episode. The APS classification criteria have recently been updated.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>6. Aging and sexThe incidence of VTE increases with age. The risk doubles every decade from the age of 50.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> Men with unprovoked VTE have a risk of recurrence 1.8 times higher than women.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>7. Residual venous occlusionResidual venous thrombosis of the lower limbs and the presence of residual pulmonary thrombosis are not good predictors of recurrence considered isolatedly, and should not be used as the sole criterion for maintaining anticoagulation.<a class="elsevierStyleCrossRefs" href="#bib0155">31–33</a>8. Post-thrombotic syndromePatients who develop post-thrombotic syndrome in the lower limbs have an almost three-fold increase in the risk of VTE recurrence. In this regard, it is considered to be a factor of special interest in influencing the decision to discontinue or not discontinue anticoagulation therapy.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>9. Antipsychotic drugsAntipsychotic therapy is a RF for the recurrence of VTE.<a class="elsevierStyleCrossRefs" href="#bib0175">35,36</a> An observational study including more than 25,000 patients found an increased risk in those treated with second-generation antipsychotics compared to those treated with first-generation antipsychotics. Prolongation of anticoagulation for the duration of treatment with these drugs should be considered on an individualized basis.<a class="elsevierStyleCrossRef" href="#bib0185">37</a>10. Recurrence risk scales in venous thromboembolic diseaseIn an attempt to stratify the risk of recurrence in patients with VTE, several prediction models based on clinical and laboratory test factors have been developed.<a class="elsevierStyleCrossRefs" href="#bib0190">38–41</a> If the risk of recurrence after 3–6 months of adequate anticoagulant treatment is <5% during the first year, withdrawal of the treatment can be considered safe (<a class="elsevierStyleCrossRef" href="#sec0135">Supplementary Table 1</a> shows the HERDOO2 and DASH models for predicting recurrence in unprovoked VTE).HERDOO2 scale<a class="elsevierStyleCrossRef" href="#bib0190">38</a>: men are considered to be at high risk of recurrence. In women, a model with four variables was found that allowed for estimating the risk of recurrence. The acronym HERDOO2 comes from HER (hyperpigmentation, edema, redness), DD during treatment ≥250 ng/ml, obesity (BMI ≥ 30 kg/m2) and age (≥65 years) (<a class="elsevierStyleCrossRef" href="#sec0135">Supplementary Table 1</a>). Women with fewer than two factors have a low risk of recurrence (1.6% in the first year), and the discontinuation of anticoagulation is considered safe (<a class="elsevierStyleCrossRef" href="#sec0135">Supplementary Table 1</a>). External validation has been made in the REVERSE II study.<a class="elsevierStyleCrossRef" href="#bib0210">42</a>DASH scale (DD, Age, Sex and Hormonal therapy<a class="elsevierStyleCrossRef" href="#bib0195">39</a>: DD qualitatively measured after the end of treatment is considered. It stratifies patients as low risk (≤1 point) and high risk (≥2 points), with an annual incidence of relapse of 3.1% and 9.3%, respectively. It is considered that anticoagulation can be safely discontinued in low-risk patients. This scale has been retrospectively validated. It could not be validated in low-risk patients over 65 years of age.<a class="elsevierStyleCrossRef" href="#bib0215">43</a>Vienna nomogram<a class="elsevierStyleCrossRef" href="#bib0200">40</a>: the risk of recurrence is estimated based on three variables: sex, location of thrombosis, and quantitative measurement of DD levels after treatment completion (<a class="elsevierStyleCrossRef" href="#sec0135">Fig. 2 Supplementary material</a>). Several validation studies have been made, with modest results in terms of predictive capacity.<a class="elsevierStyleCrossRef" href="#bib0220">44</a>DAMOVES nomogram<a class="elsevierStyleCrossRef" href="#bib0205">41</a>: the risk of recurrence is estimated based on the variables sex, age, obesity, varicose veins, qualitative measurement of DD after the end of treatment, heterozygous prothrombin gene carrier status, heterozygous factor V gene carrier status, and FVIII levels. In patients with a score of <11.5, the risk of recurrence was estimated to be <3% (<a class="elsevierStyleCrossRef" href="#sec0135">Fig. 3 Supplementary material</a>). No external validation has been made.Prediction of bleeding riskIn patients with VTE, the risk of major bleeding during the first three months of anticoagulant treatment is estimated to be 2%, with a mortality rate of 11.3%. In extended anticoagulant treatment, the risk of major bleeding decreases; in patients treated with dicoumarins, it is estimated to be 1.3–2.2/100 patient-years, while in those treated with DOACs, the estimated risk is 0.72–1.6/100 patient-years.<a class="elsevierStyleCrossRef" href="#bib0225">45</a>The prediction of bleeding risk has been made based on very heterogeneous studies including patients with provoked and unprovoked VTE in which the definition of major bleeding was not homogeneous, and most patients were treated with VKA.<a class="elsevierStyleCrossRefs" href="#bib0225">45–49</a> Several scales have been developed to estimate the risk of bleeding (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, Section 2: assessment of bleeding risk): <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•The ACCP bleeding risk scale<a class="elsevierStyleCrossRef" href="#bib0005">1</a> was developed from anticoagulation studies in patients with atrial fibrillation. It assesses risk based on many variables. The predictive value for bleeding risk in VTE is considered to be low.</li><li class="elsevierStyleListItem" id="lsti0010">•The RIETE bleeding scale<a class="elsevierStyleCrossRef" href="#bib0240">48</a> estimates the risk of bleeding during the first three months of anticoagulation in patients with VTE based on 6 variables: recent bleeding, cancer, anemia, renal failure, age >75 years, and presentation as PE. The positive predictive value of the scale in long-term treatment is low.</li><li class="elsevierStyleListItem" id="lsti0015">•The VTE-BLEED<a class="elsevierStyleCrossRef" href="#bib0245">49</a> was developed based on the RECOVER trials. Bleeding events were assessed in patients treated for 90 days with dabigatran or warfarin. Six variables are assessed: active cancer, male sex, poorly controlled arterial hypertension (AHT), anemia, gastrointestinal bleeding, age >60 years, and respiratory failure. It has been shown to have good predictive value in unprovoked VTE.</li></ul>Bleeding RFs should be identified and modifiable factors controlled to reduce this risk. If extended treatment with DOACs is indicated, the lowest effective dose should be maintained.<a class="elsevierStyleCrossRefs" href="#bib0225">45–47</a> The use of DOACs both in anticoagulant doses and in secondary prophylaxis doses makes it necessary to review the risk of bleeding in future studies. Periodic re-evaluation of the bleeding risk in patients receiving chronic anticoagulation is necessary.Follow-up of VTE and complicationsIt is necessary to plan the follow-up of patients with VTE in order to monitor the occurrence of bleeding or thrombotic complications, and to establish the appropriate type and dose of treatment.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Imaging tests over follow-up are not routinely recommended in asymptomatic patients, but should be considered in patients at high risk of developing CTEPH<a class="elsevierStyleCrossRefs" href="#bib0255">51–59</a> or with severe PTS.<a class="elsevierStyleCrossRef" href="#bib0305">61</a> D-dimer measured after the withdrawal of anticoagulation therapy helps to confirm the decision to withdraw such treatment in cases of unprovoked VTE.Chronic complications after PEPost-pulmonary embolism syndrome (PPES) is the most important complication of PE.<a class="elsevierStyleCrossRef" href="#bib0255">51</a> The Post-VTE Functional Status scale<a class="elsevierStyleCrossRef" href="#bib0260">52</a> allows for estimating severity in PPES (<a class="elsevierStyleCrossRef" href="#sec0135">Table 2 Supplementary material</a>).Post-pulmonary embolism syndrome comprises several conditions: 1) CTEPH; 2) chronic thromboembolic pulmonary disease (CTEPD); and 3) post-PE functional impairment.<a class="elsevierStyleCrossRef" href="#bib0265">53</a>CTEPH is the most serious chronic complication after PE (2%–3%). Its screening is indicated in<a class="elsevierStyleCrossRefs" href="#bib0015">3,51–56</a>:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">1)Patients with dyspnea three months after the diagnosis of PE</li><li class="elsevierStyleListItem" id="lsti0025">2)Asymptomatic patients with RFs (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>: risk factors for CTEPH), or with a high probability of CTEPH on the echocardiogram<elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0030">3)Patients with chronic thrombosis, right ventricular (RV) overload, or pulmonary arterial systolic pressure (PASP) >60 mmHg at diagnosis.</li></ul>Echocardiography is the test of choice in screening for CTEPH. If the probability proves high, the study should be completed with pulmonary ventilation-perfusion scintigraphy to assess the presence of residual thrombosis. If the echocardiographic probability is intermediate, it is advisable to determine ProBNP and perform cycle ergometry; if these tests are found to be altered, a scintigraphic study should be made. Patients with CTEPH should be referred to specialized units to assess right-side catheterization (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>: follow-up of thromboembolic disease). The treatment options include pulmonary endarterectomy, balloon angioplasty and drug therapy.<a class="elsevierStyleCrossRef" href="#bib0280">56</a> CTEPH is an indication for long-term anticoagulation. VKAs are the first choice treatment, though DOACs may be used at anticoagulant doses, albeit with less evidence.<a class="elsevierStyleCrossRef" href="#bib0285">57</a>CTEPD affects patients with chronic symptoms and residual thrombosis detected by scintigraphy after ≥3 months of adequate anticoagulation, with normal mean pulmonary artery pressure (PAP) at rest.<a class="elsevierStyleCrossRefs" href="#bib0280">56,57</a> These patients should be referred to specialized units.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Functional deterioration after PE consists of the combination of chronic symptoms after acute PE, not explained by ventilatory or cardiopulmonary causes.<a class="elsevierStyleCrossRef" href="#bib0295">59</a>Post-thrombotic syndrome of the lower limbsThis is the most common chronic complication after DVT (20%–50% after proximal DVT), and is severe in 5%–10% of the cases.<a class="elsevierStyleCrossRef" href="#bib0300">60</a> The Villalta scale allows the diagnosis and severity to be established (<a class="elsevierStyleCrossRef" href="#sec0135">Table 3 Supplementary material</a>).<a class="elsevierStyleCrossRef" href="#bib0305">61</a> The RFs for the development of PTS are the extent of DVT, ipsilateral recurrence, persistent symptoms one month after DVT diagnosis, obesity, and advanced age.<a class="elsevierStyleCrossRef" href="#bib0300">60</a> There is no effective treatment, and the usefulness of strong compression stockings is debated.<a class="elsevierStyleCrossRefs" href="#bib0295">59,61</a>Extended anticoagulant therapyDOACs are currently displacing vitamin K antagonists (VKAs) in the treatment of VTE in all its phases, for although the efficacy of both treatments is similar, DOACs offer greater safety and convenience. In some patients, VKAs are the treatment of choice: APS, particularly if triple-positive or with arterial events; and renal failure with creatinine clearance <15 ml/min.<a class="elsevierStyleCrossRefs" href="#bib0310">62–68</a>DOACs are preferred in extended treatment according to the current clinical guides.<a class="elsevierStyleCrossRefs" href="#bib0005">1–7</a> They have been shown to be effective in different studies. A meta-analysis of 6 clinical trials demonstrated the non-inferiority of DOACs versus VKAs in the prevention of VTE recurrence, with a significant reduction in the risk of major, intracranial and clinically relevant bleeding.<a class="elsevierStyleCrossRefs" href="#bib0015">3,63–67</a> These positive results have been confirmed by real-world data.<a class="elsevierStyleCrossRef" href="#bib0340">68</a>The effect of reduced doses of apixaban and rivaroxaban has been analyzed in a recent meta-analysis including the AMPLIFY-EXT<a class="elsevierStyleCrossRef" href="#bib0335">67</a> and EINSTEIN CHOICE<a class="elsevierStyleCrossRef" href="#bib0325">65</a> trials. Reduced doses were associated with a significant decrease in bleeding complications, with no relevant increase in the risk of recurrence. No dose reduction is recommended in patients with CTEPH. The different clinical and dosing specifications of DOACs are discussed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Aspirin has a very modest role in the secondary prophylaxis of unprovoked VTE, and the clinical guides do not recommend its administration in long-term treatment.<a class="elsevierStyleCrossRefs" href="#bib0345">69,70,1–4,8</a> In patients with VTE and cardiovascular disease in whom antiplatelet medication is discontinued when anticoagulation therapy is started, antiplatelet therapy should be reintroduced when anticoagulation is discontinued.<a class="elsevierStyleCrossRefs" href="#bib0005">1,8</a> In one study, treatment with sulodexine reduced the risk of recurrence after treatment discontinuation in unprovoked DVT treated with DOACs for 3–12 months.<a class="elsevierStyleCrossRef" href="#bib0355">71</a>Clinical guide recommendations for extended anticoagulant therapy<a class="elsevierStyleCrossRefs" href="#bib0005">1–8,73,74</a>The duration of anticoagulant treatment should be established 3–6 months after the start of VTE treatment, based on the balance among bleeding risk, the risk of recurrence, and the patient preferences. If there is a high risk of bleeding, discontinuation of anticoagulation should be considered after three months of treatment. If the risk of bleeding is low, the risk of recurrence should be established. The RFs for the development of VTE are determinants for recurrence. Chronic anticoagulation is recommended when the risk of recurrence is >5% per year.Conclusions of the document (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>)<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035">•Discontinuation of anticoagulation is recommended three months after a first episode of VTE caused by a resolved major transient RF, if the patient is asymptomatic.</li><li class="elsevierStyleListItem" id="lsti0040">•Indefinite anticoagulant treatment is recommended in VTE caused by major permanent RFs (active cancer, antiphospholipid syndrome, among others).</li><li class="elsevierStyleListItem" id="lsti0045">•Indefinite anticoagulation is recommended in men with unprovoked VTE.</li><li class="elsevierStyleListItem" id="lsti0050">•It is suggested to use additional tools such as the clinical characteristics, DD determination, the HERDOO2 predictive scale, and the study of thrombophilia to assess the risk of recurrence and decide on the optimal duration of anticoagulant treatment in:<a class="elsevierStyleCrossRefs" href="#bib0020">4–7</a></li><li class="elsevierStyleListItem" id="lsti0055">oWomen with unprovoked VTE.</li><li class="elsevierStyleListItem" id="lsti0060">oVTE provoked by a resolved minor transient RF.</li><li class="elsevierStyleListItem" id="lsti0065">oPatients who wish to discontinue anticoagulation when the event was unprovoked or associated with a permanent RF.</li><li class="elsevierStyleListItem" id="lsti0070">oPatients with an uncertain risk/benefit balance for indefinite anticoagulant therapy (males with unprovoked VTE and high risk of bleeding).</li></ul>Chronic anticoagulation is recommended in patients with recurrent, unprovoked VTE. In patients with recurrent VTE provoked by a major RF, anticoagulant treatment may be discontinued after completing three months from the second episode.<a class="elsevierStyleCrossRefs" href="#bib0010">2,7</a>Secondary prophylaxis with DOACs versus VKAs is recommended, except in: 1) patients with APS, particularly if triple-positive or with arterial events; and 2) patients with renal failure presenting creatinine clearance <15 ml/min.In patients with chronic anticoagulation criteria, reduced doses of rivaroxaban (10 mg every 24 h) or apixaban (2.5 mg every 12 h) are preferred, starting at 6 months.The indication for anticoagulant therapy should be re-evaluated periodically, considering the balance between risk of recurrence and bleeding. In addition, treatment adherence should be considered.As a main limitation of this document, the group developing the recommendations is not multidisciplinary, and the suggestions do not include a cost-benefit analysis — a factor that healthcare professionals need to evaluate in decision-making.Compliance with ethical guidelinesThis article is based on previously conducted studies and does not contain any new studies with human or animal participants conducted by any of the authors.FundingNo funding has been received.Expert committee members (Working Group on Venous Thromboembolic Disease of the SEMI)María Ángeles Fidalgo, Olga Madridano Cobo, Cristina Sánchez del Hoyo, Javier Martín Guerra, Gabriel Puche Palao, Nuria Ruiz-Giménez, Carme Font, Javier Pagán Escribano, Maria Ortiz and Alberto Rodríguez Iglesias.Uncited references<a class="elsevierStyleCrossRefs" href="#bib0250">[50,72]</a>." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2271487" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1893386" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2271488" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1893385" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results and recommendations" "secciones" => array:7 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Risk factors for recurrence in unprovoked VTE" "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "1. Presentation of the event" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "2. D-dimer" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "3. Obesity" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "4. Inflammatory bowel disease" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "5. Thrombophilia" ] 5 => array:2 [ "identificador" => "sec0050" "titulo" => "6. Aging and sex" ] 6 => array:2 [ "identificador" => "sec0055" "titulo" => "7. Residual venous occlusion" ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "8. Post-thrombotic syndrome" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "9. Antipsychotic drugs" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "10. Recurrence risk scales in venous thromboembolic disease" ] ] ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Prediction of bleeding risk" ] 2 => array:2 [ "identificador" => "sec0080" "titulo" => "Follow-up of VTE and complications" ] 3 => array:2 [ "identificador" => "sec0085" "titulo" => "Chronic complications after PE" ] 4 => array:2 [ "identificador" => "sec0090" "titulo" => "Post-thrombotic syndrome of the lower limbs" ] 5 => array:2 [ "identificador" => "sec0095" "titulo" => "Extended anticoagulant therapy" ] 6 => array:2 [ "identificador" => "sec0100" "titulo" => "Clinical guide recommendations for extended anticoagulant therapy" ] ] ] 7 => array:2 [ "identificador" => "sec0105" "titulo" => "Conclusions of the document (Figs. 1 and 2)" ] 8 => array:2 [ "identificador" => "sec0110" "titulo" => "Compliance with ethical guidelines" ] 9 => array:2 [ "identificador" => "sec0115" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0120" "titulo" => "Expert committee members (Working Group on Venous Thromboembolic Disease of the SEMI)" ] 11 => array:2 [ "identificador" => "sec0125" "titulo" => "Uncited references" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-06-29" "fechaAceptado" => "2024-07-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1893386" "palabras" => array:7 [ 0 => "Anticoagulation" 1 => "Deep vein thrombosis" 2 => "Hemorrhagic risk scores" 3 => "Post-pulmonary embolism syndrome" 4 => "Pulmonary embolism" 5 => "Recurrence" 6 => "Venous thromboembolism" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1893385" "palabras" => array:7 [ 0 => "Anticoagulación" 1 => "Embolia de pulmón" 2 => "Enfermedad tromboembólica venosa" 3 => "Escalas de riesgo hemorrágico" 4 => "Recurrencia" 5 => "Síndrome postembolia de pulmón" 6 => "Trombosis venosa profunda" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Venous thromboembolim (VTE) is a highly prevalent condition that requires long-term monitoring and treatment. This monitoring includes: 1) completing the etiological study and determining the risk of VTE recurrence; 2) establishing the optimal duration of anticoagulant treatment, as well as the type of therapy and its dosage; 3) estimating the risk of bleeding, and 4) identifying the occurrence of chronic complications. This consensus document, prepared by the VTE Group of the Spanish Society of Internal Medicine (SEMI), aims to update and establish consensus recommendations on these aspects. The document focuses on four aspects of management: the first includes risk factors for VTE recurrence after an unprovoked VTE episode and describes the predictive scores of VTE recurrence; the second focuses on risk factors for bleeding; the third provides recommendations for long-term follow-up in VTE, addressing specific considerations for screening chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome of the lower limbs; and the fourth provides guidance on the optimal duration of extended anticoagulant treatment, as well as the type of therapy and its dosage. For each area, an exhaustive literature review was conducted, analyzing the updated VTE clinical guidelines and recent studies. This document is intended to be a guide in the long-term management of VTE based on the most current knowledge." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La enfermedad tromboembólica venosa (ETV) es una enfermedad altamente prevalente, que requiere de seguimiento y tratamiento extendidos. Este seguimiento implica diversos aspectos clave: 1) completar el estudio etiológico y determinar el riesgo de recurrencia de futuros eventos tromboembólicos; 2) establecer la duración óptima del tratamiento anticoagulante, así como el tipo de terapia y su dosis; 3) estimar el riesgo de hemorragia, y 4) identificar la posible aparición de complicaciones crónicas. El presente documento, elaborado por el Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna, pretende actualizar y establecer recomendaciones sobre estos aspectos. El documento se centra en 4 aspectos del manejo: el primero incluye los factores de riesgo de recurrencia en la ETV no provocada y las escalas predictivas de recurrencia; el segundo se centra en los factores predictores de hemorragia; el tercero ofrece recomendaciones sobre el seguimiento a largo plazo en la ETV y aborda consideraciones específicas para el despistaje de la hipertensión pulmonar tromboembólica crónica y del síndrome postrombótico; y el cuarto brinda orientación sobre la duración óptima del tratamiento anticoagulante extendido, así como el tipo de terapia y su dosis. Para cada área se realizó una exhaustiva revisión bibliográfica analizando diferentes guías clínicas de la ETV y estudios recientes que han valorado los aspectos tratados en el artículo. El objetivo del documento es que sirva de ayuda en el manejo de la ETV a largo plazo basado en el conocimiento más actual." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0135" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4425 "Ancho" => 2435 "Tamanyo" => 1296107 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Long-term treatment of venous thromboembolic disease." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4425 "Ancho" => 2430 "Tamanyo" => 1362070 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Follow-up of venous thromboembolic disease and complications." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 4425 "Ancho" => 2425 "Tamanyo" => 1225661 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Dosage." ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 327477 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:74 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Kearon" 1 => "E.A. Akl" 2 => "J. Ornelas" 3 => "A. Blaivas" 4 => "D. Jimenez" 5 => "H. Bounameaux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2015.11.026" "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2016" "volumen" => "149" "paginaInicial" => "315" "paginaFinal" => "352" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antithrombotic therapy for VTE disease: second update of the CHEST guideline and Expert Panel report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Stevens" 1 => "S.C. Woller" 2 => "L.B. Kreuziger" 3 => "H. Bounameaux" 4 => "K. Doerschug" 5 => "G.J. Geersing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2021.07.055" "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2021" "volumen" => "160" "paginaInicial" => "e545" "paginaFinal" => "e608" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.V. Konstantinides" 1 => "G. Meyer" 2 => "C. Becattini" 3 => "H. Bueno" 4 => "G.J. Geersing" 5 => "V.P. Harjola" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01647-2019" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2019" "volumen" => "54" "paginaInicial" => "1901647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31473594" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1535610821006048" "estado" => "S300" "issn" => "15356108" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anticoagulation for patients with venous thromboembolism: when is extended treatment required?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.I. Weitz" 1 => "P. Prandoni" 2 => "P. Verhamme" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0040-1721735" "Revista" => array:6 [ "tituloSerie" => "TH Open" "fecha" => "2020" "volumen" => "4" "paginaInicial" => "e446" "paginaFinal" => "e456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33376944" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish consensus for the management of pulmonary thromboembolism" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "en nombre de los autores del Consenso" "etal" => false "autores" => array:2 [ 0 => "J.L. Lobo" 1 => "D. Jiménez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2021.04.023" "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2021" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary embolism: update on management and controversies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Duffett" 1 => "L.A. Castellucci" 2 => "M.A. Forgie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.m2177" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2020" "volumen" => "370" "paginaInicial" => "m2177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32759284" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.L. Ortel" 1 => "I. Neumann" 2 => "W. Ageno" 3 => "R. Beyth" 4 => "N.P. Clark" 5 => "A. Cuker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/bloodadvances.2020001830" "Revista" => array:5 [ "tituloSerie" => "Blood Adv" "fecha" => "2020" "volumen" => "4" "paginaInicial" => "4693" "paginaFinal" => "4738" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Who should get long-term anticoagulant therapy for venous thromboembolism and with what?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Rodger" 1 => "G. Le Gal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/bloodadvances.2018020230" "Revista" => array:5 [ "tituloSerie" => "Blood Adv" "fecha" => "2018" "volumen" => "2" "paginaInicial" => "3081" "paginaFinal" => "3087" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcommittee on Control of Anticoagulation of the SSC of the ISTH. Risk of recurrent venous thromboembolism after stopping treatment in cohort studies: recommendation for acceptable rates and standardized reporting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Kearon" 1 => "A. Iorio" 2 => "G. Palareti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1538-7836.2010.03991" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "2313" "paginaFinal" => "2315" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MARVELOUS Collaborators. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Khan" 1 => "A. Rahman" 2 => "M. Carrier" 3 => "C. Kearon" 4 => "J.I. Weitz" 5 => "S. Schulman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.l4363" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2019" "volumen" => "366" "paginaInicial" => "l4363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31340984" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants data from seven trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Boutitie" 1 => "L. Pinede" 2 => "S. Schulman" 3 => "G. Agnelli" 4 => "G. Raskob" 5 => "J. Julian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.d3036" "Revista" => array:4 [ "tituloSerie" => "BMJ" "fecha" => "2011" "volumen" => "342" "paginaInicial" => "d3036" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PROLONG Investigators. D-dimer testing to determine the duration of anticoagulation therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Palareti" 1 => "B. Cosmi" 2 => "C. Legnani" 3 => "A. Tosetto" 4 => "C. Brusi" 5 => "A. Iorio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa054444" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "355" "paginaInicial" => "1780" "paginaFinal" => "1789" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17065639" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A test in context: D-dimer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.I. Weitz" 1 => "J.C. Fredenburgh" 2 => "J.W. Eikelboom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2017.09.024" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2017" "volumen" => "70" "paginaInicial" => "2411" "paginaFinal" => "2420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29096812" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient-level meta-analysis: effect of measurement timing, threshold, and patient age on ability of D-dimer testing to assess recurrence risk after unprovoked venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Douketis" 1 => "A. Tosetto" 2 => "M. Marcucci" 3 => "T. Baglin" 4 => "M. Cushman" 5 => "S. Eichinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-153-8-201010190-00009" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2010" "volumen" => "153" "paginaInicial" => "523" "paginaFinal" => "531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956709" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: D-dimer to predict recurrent disease after stopping anticoagulant therapy for unprovoked venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Verhovsek" 1 => "J.D. Douketis" 2 => "Q. Yi" 3 => "S. Shrivastava" 4 => "R.C. Tait" 5 => "T. Baglin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-149-7-200810070-00008" "Revista" => array:7 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2008" "volumen" => "149" "paginaInicial" => "481" "paginaFinal" => "490" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18838728" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2405471220301952" "estado" => "S300" "issn" => "24054712" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic accuracy of D-Dimer testing for recurrent venous thromboembolism: a systematic review with meta-analysis.: VTE recurrence and D-dimer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.N.D. Di Minno" 1 => "I. Calcaterra" 2 => "A. Papa" 3 => "R. Lupoli" 4 => "A. Di Minno" 5 => "M. Maniscalco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2021.04.004" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2021" "volumen" => "89" "paginaInicial" => "39" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33933338" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators. D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Palareti" 1 => "B. Cosmi" 2 => "C. Legnani" 3 => "E. Antonucci" 4 => "V. de Micheli" 5 => "A. Ghirarduzzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11739-019-02216-y" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2014" "volumen" => "124" "paginaInicial" => "196" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24879813" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to d-dimer results; a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Kearon" 1 => "S. Parpia" 2 => "F.A. Spencer" 3 => "S. Schulman" 4 => "S.M. Stevens" 5 => "V. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.14458" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2019" "volumen" => "17" "paginaInicial" => "1144" "paginaFinal" => "1152" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morgagni Investigators. Residual vein thrombosis and serial D-dimer for the long-term management of patients with deep venous thrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Prandoni" 1 => "V. Vedovetto" 2 => "M. Ciammaichella" 3 => "E. Bucherini" 4 => "S. Corradini" 5 => "I. Enea" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thromres.2017.04.002" "Revista" => array:6 [ "tituloSerie" => "Thromb Res" "fecha" => "2017" "volumen" => "154" "paginaInicial" => "35" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28407492" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-vitamin K anticoagulants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Legnani" 1 => "I. Martinelli" 2 => "G. Palareti" 3 => "A. Ciavarella" 4 => "D. Poli" 5 => "W. Ageno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0219751" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2019" "volumen" => "14" "paginaInicial" => "e0219751" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31310608" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "D-dimer and reduced-dose apixaban for extended treatment after unprovoked venous thromboembolism: the Apidulcis study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Palareti" 1 => "D. Poli" 2 => "W. Ageno" 3 => "C. Legnani" 4 => "E. Antonucci" 5 => "E. Bucherini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/bloodadvances.2022007973" "Revista" => array:6 [ "tituloSerie" => "Blood Adv" "fecha" => "2022" "volumen" => "6" "paginaInicial" => "6005" "paginaFinal" => "6015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35914222" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overweight, obesity, and the risk of recurrent venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Eichinger" 1 => "G. Hron" 2 => "C. Bialonczyk" 3 => "M. Hirschl" 4 => "E. Minar" 5 => "O. Wagner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.168.15.1678" "Revista" => array:5 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2008" "volumen" => "168" "paginaInicial" => "1678" "paginaFinal" => "1683" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent venous thrombosis related to overweight and obesity: results from the MEGA follow-up study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.A. Vučković" 1 => "S.C. Cannegieter" 2 => "A. van Hylckama Vlieg" 3 => "F.R. Rosendaal" 4 => "W.M. Lijfering" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.13710" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "1430" "paginaFinal" => "1435" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28439955" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous and arterial thromboembolism in patients with inflammatory bowel diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Stadnicki" 1 => "I. Stadnicka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v27.i40.6757" "Revista" => array:5 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2021" "volumen" => "27" "paginaInicial" => "6757" "paginaFinal" => "6774" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thromboembolic events in patients with inflammatory bowel disease: a comprehensive overview" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Gala" 1 => "T. Newsome" 2 => "N. Roberson" 3 => "S.M. Lee" 4 => "M. Thekkanal" 5 => "M. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/diseases10040073" "Revista" => array:4 [ "tituloSerie" => "Diseases" "fecha" => "2022" "volumen" => "10" "paginaInicial" => "73" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective cohort study on the absolute risks of venous thromboembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S, protein C or antithrombin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.K. Mahmoodi" 1 => "J.L. Brouwer" 2 => "M.K. Ten Kate" 3 => "W.M. Lijfering" 4 => "N.J.G.M. Veeger" 5 => "A.B. Mulder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1538-7836.2010.03840.x" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "1193" "paginaFinal" => "1200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20230415" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective testing for thrombophilia in patients with first venous thrombosis: results from a retrospective family cohort study on absolute thrombotic risk for currently known thrombophilic defects in 2479 relatives" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.M. Lijfering" 1 => "J.-L.P. Brouwer" 2 => "N.J. Veeger" 3 => "I. Bank" 4 => "M. Coppens" 5 => "S. Middeldorp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2008-10-184879" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2009" "volumen" => "113" "paginaInicial" => "5314" "paginaFinal" => "5322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19139080" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACR/EULAR APS Classification Criteria Collaborators. The 2023 ACR/EULAR antiphospholipid syndrome classification criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Barbhaiya" 1 => "S. Zuily" 2 => "R. Naden" 3 => "A. Hendry" 4 => "F. Manneville" 5 => "M.C. Amigo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard-2023-224609" "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheumatol" "fecha" => "2023" "volumen" => "75" "paginaInicial" => "1687" "paginaFinal" => "1702" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. Heit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrcardio.2015.83" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Cardiol" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "464" "paginaFinal" => "474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26076949" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of recurrence after venous throm-boembolism in men and women: patient level meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Douketis" 1 => "A. Tosetto" 2 => "M. Marcucci" 3 => "T. Baglin" 4 => "B. Cosmi" 5 => "M. Cushman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.d813" "Revista" => array:4 [ "tituloSerie" => "Br Med J" "fecha" => "2011" "volumen" => "342" "paginaInicial" => "d813" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residual vein obstruction to predict the risk of recurrent venous thromboembolism in patients with deep vein thrombosis: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Carrier" 1 => "M.A. Rodger" 2 => "P.S. Wells" 3 => "M. Righini" 4 => "G.L.E. Gal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1538-7836.2011.04254.x" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2011" "volumen" => "9" "paginaInicial" => "1119" "paginaFinal" => "1125" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residual vein obstruction as a predictor for recurrent thromboembolic events after a first unprovoked episode: data from the REVERSE cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Le Gal" 1 => "M. Carrier" 2 => "M.J. Kovacs" 3 => "M.T. Betancourt" 4 => "S.R. Kahn" 5 => "P.S. Wells" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1538-7836.2011.04240.x" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2011" "volumen" => "9" "paginaInicial" => "1126" "paginaFinal" => "1132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21324057" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism: a systematic review and meta-analysis of individual participant data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Robin" 1 => "R. Le Pennec" 2 => "M. Eddy" 3 => "L. Sikora" 4 => "P.-Y. Le Roux" 5 => "M. Carrier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtha.2023.01.030" "Revista" => array:2 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2023" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The post-thrombotic syndrome: risk factors and impact on the course of thrombotic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Stain" 1 => "V. Schonauer" 2 => "E. Minar" 3 => "C. Bialonczyk" 4 => "M. Hirschl" 5 => "A. Weltermann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1538-7836.2005.01648.x" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2005" "volumen" => "3" "paginaInicial" => "2671" "paginaFinal" => "2676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16359506" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous Thromboembolism during treatment with antipsychotics: a review of current evidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.K. Jönsson" 1 => "J. Schill" 2 => "H. Olsson" 3 => "O. Spigset" 4 => "S. Hägg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40263-018-0495-7" "Revista" => array:7 [ "tituloSerie" => "CNS Drugs" "fecha" => "2018" "volumen" => "32" "paginaInicial" => "47" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29423659" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0092867422003439" "estado" => "S300" "issn" => "00928674" ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antipsychotic drugs and the risk of recurrent venous thromboembolism: a prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M. Mollard" 1 => "R. Le Mao" 2 => "C. Tromeur" 3 => "E. Le Moigne" 4 => "M. Gouillou" 5 => "B. Pan-Petesch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2018.02.030" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2018" "volumen" => "52" "paginaInicial" => "22" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29548526" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antipsychotic drugs and risk of venous thromboembolism: nested case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Parker" 1 => "C. Coupland" 2 => "J. Hippisley-Cox" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.c4245" "Revista" => array:5 [ "tituloSerie" => "BMJ." "fecha" => "2010" "volumen" => "341" "paginaInicial" => "c4245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20858909" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Rodger" 1 => "S.R. Kahn" 2 => "P.S. Wells" 3 => "D.A. Anderson" 4 => "I. Chagnon" 5 => "G. Le Gal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.080493" "Revista" => array:6 [ "tituloSerie" => "CMAJ" "fecha" => "2008" "volumen" => "179" "paginaInicial" => "417" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18725614" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Tosetto" 1 => "A. Iorio" 2 => "M. Marcucci" 3 => "T. Baglin" 4 => "M. Cushman" 5 => "S. Eichinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1538-7836.2012.04735.x" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2012" "volumen" => "10" "paginaInicial" => "1019" "paginaFinal" => "1025" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22489957" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Eichinger" 1 => "G. Heinze" 2 => "L.M. Jandeck" 3 => "P.A. Kyrle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.925214" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "121" "paginaInicial" => "1630" "paginaFinal" => "1636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20351233" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.I. Franco Moreno" 1 => "M.J. García Navarro" 2 => "J. Ortiz Sánchez" 3 => "R.M. Martín Díaz" 4 => "E. Madroñal Cerezo" 5 => "C.L. de Ancos Aracil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2015.12.010" "Revista" => array:5 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2016" "volumen" => "29" "paginaInicial" => "59" "paginaFinal" => "64" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "REVERSE II Study Investigators. Validating the HERDOO2 rule to guide treatment duration for women with unprovoked venous thrombosis: multinational prospective cohort management study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Rodger" 1 => "G. Le Gal" 2 => "D.R. Anderson" 3 => "J. Schmidt" 4 => "G. Pernod" 5 => "S.R. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.j1065" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2017" "volumen" => "356" "paginaInicial" => "j1065" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28314711" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "External validation of the DASH prediction rule: a retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Tosetto" 1 => "S. Testa" 2 => "I. Martinelli" 3 => "D. Poli" 4 => "B. Cosmi" 5 => "C. Lodigiani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.13781" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "1963" "paginaFinal" => "1970" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of recurrence after a first unprovoked venous thromboembolism: external validation of the Vienna Prediction Model with pooled individual patient data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Marcucci" 1 => "A. Iorio" 2 => "J.D. Douketis" 3 => "S. Eichinger" 4 => "A Tosetto" 5 => "T. Baglin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.12871" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2015" "volumen" => "13" "paginaInicial" => "775" "paginaFinal" => "781" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25660555" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of bleeding risk in patients who receive anticoagulant therapy for venous thromboembolism: communication from the ISTH SSC Subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.L. Den Exter" 1 => "S.C. Woller" 2 => "H. Robert-Ebadi" 3 => "C. Masias" 4 => "P.E. Morange" 5 => "D. Castelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.15776" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2022" "volumen" => "20" "paginaInicial" => "1910" "paginaFinal" => "1919" "itemHostRev" => array:3 [ "pii" => "S1535610820305973" "estado" => "S300" "issn" => "15356108" ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting anticoagulant-related bleeding in patients with ve-nous thromboembolism: a clinically oriented review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.A. Klok" 1 => "J. Kooiman" 2 => "M.V. Huisman" 3 => "S. Konstantinides" 4 => "M. Lankeit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00040714" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "201" "paginaFinal" => "210" ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term risk for major bleeding during extended oral anticoagulant therapy for first un- provoked venous thromboembolism: a systematic review an meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Khan" 1 => "T. Tritschler" 2 => "M. Kimpton" 3 => "P.S. Wells" 4 => "C. Kearon" 5 => "J.I. Weitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/m21-1094" "Revista" => array:5 [ "tituloSerie" => "Ann Int Med" "fecha" => "2021" "volumen" => "174" "paginaInicial" => "1420" "paginaFinal" => "1429" ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictive variables for major bleeding events in patients presenting with documented acute venous tromboembolism. Findings from the RIETE Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Ruiz Giménez" 1 => "C. Suárez" 2 => "R. González" 3 => "J.A. Nieto" 4 => "J.A. Todolí" 5 => "A.L. Samperiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1160/TH08-03-0193" "Revista" => array:6 [ "tituloSerie" => "Thromb Haemost" "fecha" => "2008" "volumen" => "100" "paginaInicial" => "26" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18612534" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of bleeding events in patients with venous thromboembolism on stable anticoagulation treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.A. Klok" 1 => "V. Hösel" 2 => "A. Clemens" 3 => "W.D. Yollo" 4 => "C. Tilke" 5 => "S. Schulman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.00280-2016" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2016" "volumen" => "48" "paginaInicial" => "1369" "paginaFinal" => "1376" ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term association of venous thromboembolism with frailty, physical functioning, and quality of life: the atherosclerosis risk in communities study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.L. Lutsey" 1 => "B.G. Windham" 2 => "J.R. Misialek" 3 => "M. Cushman" 4 => "A. Kucharska-Newton" 5 => "S. Basu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/JAHA.119.015656" "Revista" => array:5 [ "tituloSerie" => "J Am Heart Assoc" "fecha" => "2020" "volumen" => "9" "paginaInicial" => "e015656" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32476561" "web" => "Medline" ] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0255" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determinants and management of the post-pulmonary embolism syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.J.A.M. Boon" 1 => "M.V. Huisman" 2 => "F.A. Klok" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0041-1722964" "Revista" => array:5 [ "tituloSerie" => "Semin Respir Crit Care Med" "fecha" => "2021" "volumen" => "42" "paginaInicial" => "299" "paginaFinal" => "307" ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0260" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The post-PE syndrome: a new concept for chronic complications of pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.A. Klok" 1 => "T. van der Hulle" 2 => "P.L. den Exter" 3 => "M. Lankeit" 4 => "M.V. Huisman" 5 => "S. Konstantinides" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.blre.2014.07.003" "Revista" => array:6 [ "tituloSerie" => "Blood Rev" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "221" "paginaFinal" => "226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25168205" "web" => "Medline" ] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0265" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measuring functional limitations after venous thromboembolism: optimization of the Post-VTE Functional Status (PVFS) scale" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Boon" 1 => "S. Barco" 2 => "L. Bertoletti" 3 => "W. Ghanima" 4 => "M.V. Huisman" 5 => "S.R. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thromres.2020.03.020" "Revista" => array:5 [ "tituloSerie" => "Thromb Res" "fecha" => "2020" "volumen" => "190" "paginaInicial" => "45" "paginaFinal" => "51" ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0270" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.A. Klok" 1 => "W. Ageno" 2 => "C. Ay" 3 => "M. Bäck" 4 => "S. Barco" 5 => "L. Bertoletti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehab816" "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2022" "volumen" => "43" "paginaInicial" => "183" "paginaFinal" => "189" ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0275" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary chronic thromboembolic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Ramírez" 1 => "R. Otero" 2 => "J.A. Barberà" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbr.2020.03.007" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2020" "volumen" => "56" "paginaInicial" => "314" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35373741" "web" => "Medline" ] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0280" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Humbert" 1 => "G. Kovacs" 2 => "M.M. Hoeper" 3 => "R. Badagliacca" 4 => "R.M.F. Berger" 5 => "M. Brida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehac237" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2022" "volumen" => "43" "paginaInicial" => "3618" "paginaFinal" => "3731" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36017548" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0285" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of oral anticoagulant drugs in patients with pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Demelo-Rodriguez" 1 => "F. Galeano-Valle" 2 => "M. Proietti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hfc.2022.08.018" "Revista" => array:6 [ "tituloSerie" => "Heart Fail Clin" "fecha" => "2023" "volumen" => "19" "paginaInicial" => "97" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36435577" "web" => "Medline" ] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0290" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The post-thrombotic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.R. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/asheducation-2016.1.413" "Revista" => array:5 [ "tituloSerie" => "Hematology Am Soc Hematol Educ Program." "fecha" => "2016" "volumen" => "2016" "paginaInicial" => "413" "paginaFinal" => "418" ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0295" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of the post-thrombotic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.P. Galanaud" 1 => "M. Monreal" 2 => "S.R. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thromres.2017.07.026" "Revista" => array:5 [ "tituloSerie" => "Thromb Res" "fecha" => "2018" "volumen" => "164" "paginaInicial" => "100" "paginaFinal" => "109" ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0300" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Society of Vascular Medicine (ESVM). Post-thrombotic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Visonà" 1 => "I. Quere" 2 => "L. Mazzolai" 3 => "M. Amitrano" 4 => "M. Lugli" 5 => "J. Madaric" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1024/0301-1526/a000946" "Revista" => array:6 [ "tituloSerie" => "Vasa" "fecha" => "2021" "volumen" => "50" "paginaInicial" => "331" "paginaFinal" => "340" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33720757" "web" => "Medline" ] ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0305" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound for lower extremity deep venous thrombosis: multidisciplinary recommendations from the society of radiologists in ultrasound consensus conference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Needleman" 1 => "J.J. Cronan" 2 => "M.P. Lilly" 3 => "G.J. Merli" 4 => "S. Adhikari" 5 => "B.S. Hertzberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.117.030687" "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2018" "volumen" => "137" "paginaInicial" => "1505" "paginaFinal" => "1515" ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0310" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Van Es" 1 => "M. Coppens" 2 => "S. Schulman" 3 => "S. Middeldorp" 4 => "H.R. Büller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2014-04-571232" "Revista" => array:5 [ "tituloSerie" => "Blood" "fecha" => "2014" "volumen" => "124" "paginaInicial" => "1968" "paginaFinal" => "1975" ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0315" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended use of dabigatran, warfarin, or placebo in venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Chulman" 1 => "C. Kearon" 2 => "A.K. Kakkar" 3 => "S. Schellong" 4 => "H. Eriksson" 5 => "D. Baanstra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1113697" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2013" "volumen" => "368" "paginaInicial" => "709" "paginaFinal" => "718" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23425163" "web" => "Medline" ] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0320" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral rivaroxaban for symptomatic venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Bauersachs" 1 => "S.D. Berkowitz" 2 => "B. Brenner" 3 => "H.R. Buller" 4 => "H. Decousus" 5 => "A.S. Gallus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1007903" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "363" "paginaInicial" => "2499" "paginaFinal" => "2510" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21128814" "web" => "Medline" ] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0325" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rivaroxaban or aspirin for extended treatment of venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.I. Weitz" 1 => "A.W.A. Lensing" 2 => "M.H. Prins" 3 => "R. Bauersachs" 4 => "J. Beyer-Westendorf" …1 ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1700518" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "volumen" => "376" "paginaInicial" => "1211" "paginaFinal" => "1222" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0330" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended duration of anticoagulation with edoxaban in patients with venous thromboembolism: a post hoc analysis of the Hokusai-VTE study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2352-3026(16)00023-5" "Revista" => array:6 [ "tituloSerie" => "Lancet Haematol" "fecha" => "2016" "volumen" => "3" "paginaInicial" => "e228" "paginaFinal" => "e236" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0335" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1302507" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2013" "volumen" => "369" "paginaInicial" => "799" "paginaFinal" => "808" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0340" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness and safety of nonvitamin K oral anticoagulants rivaroxaban and apixaban in patients with venous thromboembolism: a meta-analysis of real-world studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2022/2756682" "Revista" => array:4 [ "tituloSerie" => "Cardiovasc Ther" "fecha" => "2022" "volumen" => "2022" "paginaInicial" => "2756682" ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0345" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ASPIRE Investigators. Low-dose aspirin for preventing recurrent venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1210384" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "367" "paginaInicial" => "1979" "paginaFinal" => "1987" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0350" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspirin for preventing the recurrence of venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1114238" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "1959" "paginaFinal" => "1967" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0355" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sulodexide for the prevention of recurrent venous thromboembolism: the Sulodexide in Secondary Prevention of Recurrent Deep Vein Thrombosis (SURVET) study: a multicenter, randomized, double-blind, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.115.016930" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "132" "paginaInicial" => "1891" "paginaFinal" => "1897" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0360" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term versus extended anticoagulant treatment for unprovoked venous thromboembolism: a survey on guideline adherence and physicians’ considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thromres.2019.10.003" "Revista" => array:5 [ "tituloSerie" => "Thromb Res" "fecha" => "2019" "volumen" => "183" "paginaInicial" => "49" "paginaFinal" => "55" ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0365" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended anticoagulation for VTE: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2019.02.402" "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2019" "volumen" => "155" "paginaInicial" => "1199" "paginaFinal" => "1216" ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0370" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjpc/zwab088" "Revista" => array:6 [ "tituloSerie" => "Eur J Prev Cardiol" "fecha" => "2022" "volumen" => "29" "paginaInicial" => "1248" "paginaFinal" => "1263" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/unassign/S2254887424001280/v1_202410160423/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/22548874/unassign/S2254887424001280/v1_202410160423/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887424001280?idApp=WRCEE"]

 array:22 [
  "pii" => "S2254887424001280"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2024.10.004"
  "estado" => "S100"
  "fechaPublicacion" => "2024-10-16"
  "aid" => "2241"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:17 [
    "pii" => "S2254887424001292"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2024.10.005"
    "estado" => "S5"
    "fechaPublicacion" => "2024-10-16"
    "aid" => "2240"
    "copyright" => "Elsevier Ltd"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:8 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Measles in the emergency room&#58; the enemy is still there"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sarampi&#243;n en sala de urgencias&#58; el enemigo sigue ah&#237;"
        ]
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Ena"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ena"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887424001292?idApp=WRCEE"
    "url" => "/22548874/unassign/S2254887424001292/v1_202410160425/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "S2254887424001103"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2024.08.001"
    "estado" => "S200"
    "fechaPublicacion" => "2024-08-28"
    "aid" => "2233"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Soluble receptor for advanced glycation end-products positively correlated to kidney injury with coronary heart disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "El receptor soluble para productos finales de glicaci&#243;n avanzada se correlacion&#243; positivamente con la lesi&#243;n renal con la enfermedad coronaria"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1825
              "Ancho" => 3341
              "Tamanyo" => 319191
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0015"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Correlation analysis between sRAGE and uACR in CHD patients &#40;A&#41;&#44; and ROC analysis of sRAGE&#44; UMA&#44; eGFR&#44; SCr&#44; UCr&#44; Albumin and BUN with uACR&#160;&#8805;&#160;30&#160;mg&#47;g in CHD patients &#40;B&#41;&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Each dot represents an individual patient&#46; BUN&#58; blood urea nitrogen&#59; CHD&#58; coronary heart disease&#59; eGFR&#58; estimated Glomerular Filtration Rate&#59; ROC&#58; receiver operating characteristic&#59; SCr&#58; serum creatinine&#59; sRAGE&#58; soluble receptor for advanced glycation end products&#59; uACR&#58; urinary albumin to creatinine ratio&#59; UCr&#58; urine creatinine&#59; UMA&#58; urine microalbumin&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lu Chen, Xiang-Jun Zeng, Xin-Ying Guo, Jian Liu, Feng-He Du, Cai-Xia Guo"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Lu"
              "apellidos" => "Chen"
            ]
            1 => array:2 [
              "nombre" => "Xiang-Jun"
              "apellidos" => "Zeng"
            ]
            2 => array:2 [
              "nombre" => "Xin-Ying"
              "apellidos" => "Guo"
            ]
            3 => array:2 [
              "nombre" => "Jian"
              "apellidos" => "Liu"
            ]
            4 => array:2 [
              "nombre" => "Feng-He"
              "apellidos" => "Du"
            ]
            5 => array:2 [
              "nombre" => "Cai-Xia"
              "apellidos" => "Guo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256524001498"
        "doi" => "10.1016/j.rce.2024.06.016"
        "estado" => "S200"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256524001498?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887424001103?idApp=WRCEE"
    "url" => "/22548874/unassign/S2254887424001103/v1_202408280421/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
    "titulo" => "Long-term monitoring and treatment of venous thromboembolic disease&#58; Recommendations of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine 2024"
    "tieneTextoCompleto" => true
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Mart&#237;n del Pozo, M&#46; Mart&#237;n Asenjo, A&#46;I&#46; Franco Moreno, E&#46; Usandizaga, F&#46; Galeano Valle"
        "autores" => array:5 [
          0 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Mart&#237;n del Pozo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Mart&#237;n Asenjo"
            "email" => array:1 [
              0 => "miguel.martin.asenjo@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;I&#46;"
            "apellidos" => "Franco Moreno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Usandizaga"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Galeano Valle"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Infanta Sofia&#44; Madrid&#44; Universidad Europea de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Cl&#237;nico Universitario de Valladolid&#44; Universidad de Valladolid&#44; Valladolid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Intanta Leonor&#44; Madrid&#44; Universidad Complutense de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Medicina Interna&#44; Cl&#237;nica Privada"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital General Universitaio Grergorio Mara&#241;on&#44; Universidad Complutense de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Seguimiento y tratamiento de la enfermedad tromboemb&#243;lica venosa a largo plazo&#58; recomendaciones del Grupo de Enfermedad Tromboemb&#243;lica de la Sociedad Espa&#241;ola de Medicina Interna 2024"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 4425
            "Ancho" => 2430
            "Tamanyo" => 1362070
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Follow-up of venous thromboembolic disease and complications&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In order to establish the optimal duration of anticoagulant therapy in patients with venous thromboembolic disease &#40;VTE&#41;&#44; a balance between the risk of recurrence and the risk of bleeding should be made&#46; Anticoagulation in VTE is divided into three phases&#58; a&#41; initial treatment &#40;0&#8211;21 days&#41;&#59; b&#41; primary treatment or prevention phase &#40;21 days&#8211;3 months&#41;&#59; and c&#41; extended treatment or secondary prevention &#40;from 3 months&#41;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Fig&#46; 1 Supplementary material</a>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Traditionally&#44; the duration of anticoagulant therapy was based on the etiology of VTE&#44; considering the dichotomy&#58; provoked VTE or unprovoked VTE&#46; This distinction is considered to be limited&#44; however&#46; In this regard&#44; the individual risk factors &#40;RFs&#41; of the patient should also be assessed&#46; The RFs for VTE and the exposure time are determinants of recurrence risk over follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;6</span></a> In a recent meta-analysis&#44; the risk of recurrence in unprovoked VTE after the discontinuation of anticoagulant therapy was 10&#37; in the first year and 25&#37; at 5 years&#46; In provoked VTE&#44; the risk is dependent on the RF involved&#44; being 3&#37; at 5 years for major transient RFs&#59; 5&#37; in the first year &#40;and 15&#37; at 5 years&#41; for minor transient RFs&#59; and 15&#37; annually for permanent RFs such as cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The anticoagulant treatment phases in VTE are shown in &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; Section 1&#58; study of the presence of risk factors&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The International Society of Thrombosis and Haemostasis suggests maintaining long-term anticoagulant therapy when the estimated risk of recurrence is greater than 5&#37; in the first year &#40;or 15&#37; at 5 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Anticoagulant therapy reduces the risk of recurrence during its administration&#44; and treatment discontinuation is associated with an increased risk of thrombosis&#44; which is higher in the first 6 months&#46; Anticoagulation is also associated with an increased bleeding risk&#46; In addition&#44; the mortality associated with bleeding during anticoagulation is 2&#8211;3 times higher than that associated with the risk of recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The main clinical practice guides recommend a minimum of three months of anticoagulant treatment for all patients with VTE&#46; The duration of anticoagulant treatment should subsequently be established based on the risk of bleeding and the risk of recurrence&#44; and the patient preferences moreover should be incorporated into the decision-making process&#46; This balance is dynamic and can be modified during patient follow-up&#46; We know that treatment with direct oral anticoagulants &#40;DOACs&#41; is associated with a reduced risk of bleeding&#44; which has modified the risk-benefit profile associated with extended therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;6&#8211;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The purpose of this document is to provide an update on the main guidelines for the long-term management of VTE&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">To prepare this document&#44; a group was formed with the main function of reviewing and synthesizing the available evidence and formulating conclusions and recommendations&#46; A literature search was made in the PubMed&#44; Cochrane&#44; and Scopus &#40;Web of Science&#41; databases&#44; including clinical practice guides&#44; original articles&#44; reviews &#40;systematic or narrative&#41;&#44; and meta-analyses in order to identify the most relevant evidence in accordance with the objective of this consensus document&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This document consists of four parts&#58; the first part includes the RFs of recurrence in unprovoked VTE and the predictive scales of recurrence&#59; the second part describes the predictors of bleeding&#59; the third part focuses on the recommendations in the long-term follow-up of VTE&#44; addressing specific considerations for screening chronic thromboembolic pulmonary hypertension &#40;CTEPH&#41; and post-thrombotic syndrome &#40;PTS&#41;&#59; and the fourth part includes recommendations on the duration of extended anticoagulant treatment&#44; as well as on the type of therapy and its dose&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The group developing the recommendations drafted the manuscript&#44; which underwent successive reviews by this same group&#46; Finally&#44; the document was reviewed by a committee of experts&#44; members of the Working Group on Venous Thromboembolic Disease of the Spanish Society of Internal Medicine &#40;Sociedad Espa&#241;ola de Medicina Interna &#91;SEMI&#93;&#41;&#44; and an external reviewer&#44; until its final approval&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results and recommendations</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Risk factors for recurrence in unprovoked VTE</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">1&#46; Presentation of the event</span><p id="par0045" class="elsevierStylePara elsevierViewall">For many years&#44; the risk of recurrence associated with proximal deep vein thrombosis &#40;DVT&#41; and pulmonary embolism &#40;PE&#41; was considered to be similar and greater than the risk of recurrence following distal DVT&#46; The meta-analysis of the MARVELOUS study analyzed recurrence after treatment discontinuation in unprovoked VTE over 10 years&#46; The risk of recurrence in distal DVT was found to be significantly lower than in proximal DVT &#40;95&#37;CI relative risk &#91;RR&#93; 0&#46;2 &#91;0&#46;05&#8211;0&#46;7&#93;&#41;&#46; The risk of recurrence in proximal DVT was higher than in PE &#40;95&#37;CI RR 1&#46;4 &#91;1&#46;1&#8211;1&#46;7&#93;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Pulmonary embolism is three times more likely to recur as PE than as DVT&#44; whereas DVT recurs more often as DVT&#46; The type of VTE is an important factor in deciding the duration of treatment&#44; since recurrence as PE results in greater mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">2&#46; D-dimer</span><p id="par0055" class="elsevierStylePara elsevierViewall">D-dimer &#40;DD&#41; measured approximately one month after anticoagulation discontinuation is a predictor of recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The DD levels are higher in women than in men and increase with age&#44; so the cut-off point should be adjusted in patients over 50 years of age&#44; multiplying age by 10&#46; Comorbidities increase the DD levels&#44; because a proinflammatory state is generated&#46; In cancer&#44; DD increases and has a lower negative predictive value&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;18</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Several meta-analyses have shown that increased DD is related to a 2&#46;2&#8211;2&#46;5-fold increase in the risk of unprovoked VTE recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a> The DULCIS study assessed the relationship between DD levels at regular measurements during the first three months after the discontinuation of anticoagulant therapy and the development of VTE recurrence over two years of follow-up&#46; The risk of recurrence in untreated patients with positive DD versus those with negative DD was three times higher &#40;95&#37;CI hazard ratio &#91;HR&#93; 2&#46;92 &#91;1&#46;87&#8211;9&#46;72&#93;&#41;&#44; thus suggesting the reintroduction of anticoagulation in patients with positive DD&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Kearon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> reported a higher risk of recurrence in unprovoked VTE and negative DD in men than in women &#40;9&#46;7 vs 5&#46;4 recurrences&#47;100 patients&#47;year&#41;&#46; Based on these results&#44; the authors recommend maintaining anticoagulation indefinitely in men with negative DD&#46; These results have not been validated&#44; however&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">D-dimer has been associated with the risk of recurrence in patients with VTE provoked by a minor RF&#44; and some authors suggest the maintenance of anticoagulant therapy in patients with positive DD&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients treated with DOACs have higher DD levels than those treated with dicoumarins&#44; though they do not experience more recurrences&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The APIDULCIS study recently questioned the value of DD as a predictor of recurrence in unprovoked VTE&#46; Serial DD measurements were made in an unprovoked VTE cohort&#59; patients with positive DD over follow-up were treated with apixaban&#44; and those with negative DD were not anticoagulated&#46; The patients with negative DD had an increased risk of thrombotic complications &#40;95&#37;CI HR 8&#46;2 &#91;3&#46;2&#8211;25&#46;3&#93;&#41; compared with the DD-positive patients treated with apixaban&#46; Based on these data&#44; the authors suggested that all patients with unprovoked VTE should be maintained on low-dose apixaban&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">3&#46; Obesity</span><p id="par0085" class="elsevierStylePara elsevierViewall">The impact of obesity on the risk of recurrence has not been well established&#46; Eichinger et al&#46; reported a 60&#37; increase in the risk of recurrence in patients with a body mass index &#40;BMI&#41;&#8239;&#62;&#8239;30&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> as compared to those with BMI&#8239;&#60;&#8239;30&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#46; However&#44; a recent meta-analysis has found insufficient evidence to establish a relationship between obesity and the risk of recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">4&#46; Inflammatory bowel disease</span><p id="par0090" class="elsevierStylePara elsevierViewall">Patients with inflammatory bowel disease &#40;IBD&#41; who suffered an unprovoked VTE episode have a 2&#46;5-fold increased risk of recurrence as compared to patients without IBD&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In patients with IBD and clinical remission who experience an episode of unprovoked VTE&#44; some clinical guides recommend indefinite anticoagulation&#46; However&#44; if VTE occurs with active disease&#44; it is recommended that patients receive anticoagulation until the IBD activity is controlled for a minimum of three months&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">5&#46; Thrombophilia</span><p id="par0095" class="elsevierStylePara elsevierViewall">The influence of thrombophilia assessment in deciding the duration of anticoagulation is a controversial issue&#46; The alterations most commonly related to possible recurrence must be taken into account&#46; Forms of hereditary thrombophilia include mutation for Leiden factor V or G20210A mutation of the prothrombin gene&#44; the deficiency of natural anticoagulants &#40;protein C&#44; protein S&#44; and antithrombin&#41;&#44; and combined deficits&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> Thrombophilia testing should not be performed in the acute phase&#44; because&#58; 1&#41; natural anticoagulant proteins are consumed during the acute phase of thrombosis&#59; 2&#41; testing should be performed in the absence of anticoagulant treatment&#59; and 3&#41; its result will not modify the treatment decision during the first three months&#46; In general&#44; the presence of thrombophilia slightly increases the risk of recurrence after a first episode of VTE&#44; and it should be interpreted as an additional factor to clinical factors&#44; except in high-risk forms of thrombophilia&#46; Among these&#44; the most common is antiphospholipid syndrome &#40;APS&#41;&#44; which is the main cause of acquired thrombophilia &#40;present in 9&#37; of all VTE events&#41;&#44; where due to the high risk of recurrence&#44; long-term anticoagulation is recommended after a first thrombotic episode&#46; The APS classification criteria have recently been updated&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">6&#46; Aging and sex</span><p id="par0100" class="elsevierStylePara elsevierViewall">The incidence of VTE increases with age&#46; The risk doubles every decade from the age of 50&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Men with unprovoked VTE have a risk of recurrence 1&#46;8 times higher than women&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">7&#46; Residual venous occlusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Residual venous thrombosis of the lower limbs and the presence of residual pulmonary thrombosis are not good predictors of recurrence considered isolatedly&#44; and should not be used as the sole criterion for maintaining anticoagulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#8211;33</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">8&#46; Post-thrombotic syndrome</span><p id="par0110" class="elsevierStylePara elsevierViewall">Patients who develop post-thrombotic syndrome in the lower limbs have an almost three-fold increase in the risk of VTE recurrence&#46; In this regard&#44; it is considered to be a factor of special interest in influencing the decision to discontinue or not discontinue anticoagulation therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">9&#46; Antipsychotic drugs</span><p id="par0115" class="elsevierStylePara elsevierViewall">Antipsychotic therapy is a RF for the recurrence of VTE&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35&#44;36</span></a> An observational study including more than 25&#44;000 patients found an increased risk in those treated with second-generation antipsychotics compared to those treated with first-generation antipsychotics&#46; Prolongation of anticoagulation for the duration of treatment with these drugs should be considered on an individualized basis&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">10&#46; Recurrence risk scales in venous thromboembolic disease</span><p id="par0120" class="elsevierStylePara elsevierViewall">In an attempt to stratify the risk of recurrence in patients with VTE&#44; several prediction models based on clinical and laboratory test factors have been developed&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;41</span></a> If the risk of recurrence after 3&#8211;6 months of adequate anticoagulant treatment is &#60;5&#37; during the first year&#44; withdrawal of the treatment can be considered safe &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Supplementary Table 1</a> shows the HERDOO2 and DASH models for predicting recurrence in unprovoked VTE&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HERDOO2 scale</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#58; men are considered to be at high risk of recurrence&#46; In women&#44; a model with four variables was found that allowed for estimating the risk of recurrence&#46; The acronym HERDOO2 comes from HER &#40;<span class="elsevierStyleItalic">hyperpigmentation&#44; edema&#44; redness</span>&#41;&#44; DD during treatment &#8805;250&#8239;ng&#47;ml&#44; obesity &#40;BMI&#8239;&#8805;&#8239;30&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and age &#40;&#8805;65 years&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Supplementary Table 1</a>&#41;&#46; Women with fewer than two factors have a low risk of recurrence &#40;1&#46;6&#37; in the first year&#41;&#44; and the discontinuation of anticoagulation is considered safe &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Supplementary Table 1</a>&#41;&#46; External validation has been made in the REVERSE II study&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">DASH scale</span> &#40;DD&#44; <span class="elsevierStyleItalic">Age&#44; Sex and Hormonal therapy</span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#58; DD qualitatively measured after the end of treatment is considered&#46; It stratifies patients as low risk &#40;&#8804;1 point&#41; and high risk &#40;&#8805;2 points&#41;&#44; with an annual incidence of relapse of 3&#46;1&#37; and 9&#46;3&#37;&#44; respectively&#46; It is considered that anticoagulation can be safely discontinued in low-risk patients&#46; This scale has been retrospectively validated&#46; It could not be validated in low-risk patients over 65 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Vienna <span class="elsevierStyleItalic">nomogram</span></span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a>&#58; the risk of recurrence is estimated based on three variables&#58; sex&#44; location of thrombosis&#44; and quantitative measurement of DD levels after treatment completion &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Fig&#46; 2 Supplementary material</a>&#41;&#46; Several validation studies have been made&#44; with modest results in terms of predictive capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">DAMOVES nomogram</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#58; the risk of recurrence is estimated based on the variables sex&#44; age&#44; obesity&#44; varicose veins&#44; qualitative measurement of DD after the end of treatment&#44; heterozygous prothrombin gene carrier status&#44; heterozygous factor V gene carrier status&#44; and FVIII levels&#46; In patients with a score of &#60;11&#46;5&#44; the risk of recurrence was estimated to be &#60;3&#37; &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Fig&#46; 3 Supplementary material</a>&#41;&#46; No external validation has been made&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Prediction of bleeding risk</span><p id="par0145" class="elsevierStylePara elsevierViewall">In patients with VTE&#44; the risk of major bleeding during the first three months of anticoagulant treatment is estimated to be 2&#37;&#44; with a mortality rate of 11&#46;3&#37;&#46; In extended anticoagulant treatment&#44; the risk of major bleeding decreases&#59; in patients treated with dicoumarins&#44; it is estimated to be 1&#46;3&#8211;2&#46;2&#47;100 patient-years&#44; while in those treated with DOACs&#44; the estimated risk is 0&#46;72&#8211;1&#46;6&#47;100 patient-years&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The prediction of bleeding risk has been made based on very heterogeneous studies including patients with provoked and unprovoked VTE in which the definition of major bleeding was not homogeneous&#44; and most patients were treated with VKA&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#8211;49</span></a> Several scales have been developed to estimate the risk of bleeding &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; Section 2&#58; assessment of bleeding risk&#41;&#58; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">The ACCP bleeding risk scale<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> was developed from anticoagulation studies in patients with atrial fibrillation&#46; It assesses risk based on many variables&#46; The predictive value for bleeding risk in VTE is considered to be low&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">The RIETE <span class="elsevierStyleItalic">bleeding scale</span><a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> estimates the risk of bleeding during the first three months of anticoagulation in patients with VTE based on 6 variables&#58; recent bleeding&#44; cancer&#44; anemia&#44; renal failure&#44; age &#62;75 years&#44; and presentation as PE&#46; The positive predictive value of the scale in long-term treatment is low&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">The VTE-BLEED<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> was developed based on the RECOVER trials&#46; Bleeding events were assessed in patients treated for 90 days with dabigatran or warfarin&#46; Six variables are assessed&#58; active cancer&#44; male sex&#44; poorly controlled arterial hypertension &#40;AHT&#41;&#44; anemia&#44; gastrointestinal bleeding&#44; age &#62;60 years&#44; and respiratory failure&#46; It has been shown to have good predictive value in unprovoked VTE&#46;</p></li></ul></p><p id="par0170" class="elsevierStylePara elsevierViewall">Bleeding RFs should be identified and modifiable factors controlled to reduce this risk&#46; If extended treatment with DOACs is indicated&#44; the lowest effective dose should be maintained&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#8211;47</span></a> The use of DOACs both in anticoagulant doses and in secondary prophylaxis doses makes it necessary to review the risk of bleeding in future studies&#46; Periodic re-evaluation of the bleeding risk in patients receiving chronic anticoagulation is necessary&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Follow-up of VTE and complications</span><p id="par0175" class="elsevierStylePara elsevierViewall">It is necessary to plan the follow-up of patients with VTE in order to monitor the occurrence of bleeding or thrombotic complications&#44; and to establish the appropriate type and dose of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Imaging tests over follow-up are not routinely recommended in asymptomatic patients&#44; but should be considered in patients at high risk of developing CTEPH<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">51&#8211;59</span></a> or with severe PTS&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a> D-dimer measured after the withdrawal of anticoagulation therapy helps to confirm the decision to withdraw such treatment in cases of unprovoked VTE&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Chronic complications after PE</span><p id="par0180" class="elsevierStylePara elsevierViewall">Post-pulmonary embolism syndrome &#40;PPES&#41; is the most important complication of PE&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> The <span class="elsevierStyleItalic">Post-VTE Functional Status scale</span><a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> allows for estimating severity in PPES &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Table 2 Supplementary material</a>&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Post-pulmonary embolism syndrome comprises several conditions&#58; 1&#41; CTEPH&#59; 2&#41; chronic thromboembolic pulmonary disease &#40;CTEPD&#41;&#59; and 3&#41; post-PE functional impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">CTEPH is the most serious chronic complication after PE &#40;2&#37;&#8211;3&#37;&#41;&#46; Its screening is indicated in<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;51&#8211;56</span></a>&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Patients with dyspnea three months after the diagnosis of PE</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#41;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Asymptomatic patients with RFs &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#58; risk factors for CTEPH&#41;&#44; or with a high probability of CTEPH on the echocardiogram</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#41;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Patients with chronic thrombosis&#44; right ventricular &#40;RV&#41; overload&#44; or pulmonary arterial systolic pressure &#40;PASP&#41; &#62;60&#8239;mmHg at diagnosis&#46;</p></li></ul></p><p id="par0210" class="elsevierStylePara elsevierViewall">Echocardiography is the test of choice in screening for CTEPH&#46; If the probability proves high&#44; the study should be completed with pulmonary ventilation-perfusion scintigraphy to assess the presence of residual thrombosis&#46; If the echocardiographic probability is intermediate&#44; it is advisable to determine ProBNP and perform cycle ergometry&#59; if these tests are found to be altered&#44; a scintigraphic study should be made&#46; Patients with CTEPH should be referred to specialized units to assess right-side catheterization &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#58; follow-up of thromboembolic disease&#41;&#46; The treatment options include pulmonary endarterectomy&#44; balloon angioplasty and drug therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> CTEPH is an indication for long-term anticoagulation&#46; VKAs are the first choice treatment&#44; though DOACs may be used at anticoagulant doses&#44; albeit with less evidence&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">CTEPD affects patients with chronic symptoms and residual thrombosis detected by scintigraphy after &#8805;3 months of adequate anticoagulation&#44; with normal mean pulmonary artery pressure &#40;PAP&#41; at rest&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56&#44;57</span></a> These patients should be referred to specialized units&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Functional deterioration after PE consists of the combination of chronic symptoms after acute PE&#44; not explained by ventilatory or cardiopulmonary causes&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Post-thrombotic syndrome of the lower limbs</span><p id="par0225" class="elsevierStylePara elsevierViewall">This is the most common chronic complication after DVT &#40;20&#37;&#8211;50&#37; after proximal DVT&#41;&#44; and is severe in 5&#37;&#8211;10&#37; of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> The Villalta scale allows the diagnosis and severity to be established &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Table 3 Supplementary material</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a> The RFs for the development of PTS are the extent of DVT&#44; ipsilateral recurrence&#44; persistent symptoms one month after DVT diagnosis&#44; obesity&#44; and advanced age&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> There is no effective treatment&#44; and the usefulness of strong compression stockings is debated&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">59&#44;61</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Extended anticoagulant therapy</span><p id="par0230" class="elsevierStylePara elsevierViewall">DOACs are currently displacing vitamin K antagonists &#40;VKAs&#41; in the treatment of VTE in all its phases&#44; for although the efficacy of both treatments is similar&#44; DOACs offer greater safety and convenience&#46; In some patients&#44; VKAs are the treatment of choice&#58; APS&#44; particularly if triple-positive or with arterial events&#59; and renal failure with creatinine clearance &#60;15&#8239;ml&#47;min&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#8211;68</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">DOACs are preferred in extended treatment according to the current clinical guides&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;7</span></a> They have been shown to be effective in different studies&#46; A meta-analysis of 6 clinical trials demonstrated the non-inferiority of DOACs versus VKAs in the prevention of VTE recurrence&#44; with a significant reduction in the risk of major&#44; intracranial and clinically relevant bleeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;63&#8211;67</span></a> These positive results have been confirmed by real-world data&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The effect of reduced doses of apixaban and rivaroxaban has been analyzed in a recent meta-analysis including the AMPLIFY-EXT<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a> and EINSTEIN CHOICE<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> trials&#46; Reduced doses were associated with a significant decrease in bleeding complications&#44; with no relevant increase in the risk of recurrence&#46; No dose reduction is recommended in patients with CTEPH&#46; The different clinical and dosing specifications of DOACs are discussed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">Aspirin has a very modest role in the secondary prophylaxis of unprovoked VTE&#44; and the clinical guides do not recommend its administration in long-term treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">69&#44;70&#44;1&#8211;4&#44;8</span></a> In patients with VTE and cardiovascular disease in whom antiplatelet medication is discontinued when anticoagulation therapy is started&#44; antiplatelet therapy should be reintroduced when anticoagulation is discontinued&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;8</span></a> In one study&#44; treatment with sulodexine reduced the risk of recurrence after treatment discontinuation in unprovoked DVT treated with DOACs for 3&#8211;12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">71</span></a></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Clinical guide recommendations for extended anticoagulant therapy<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;8&#44;73&#44;74</span></a></span><p id="par0250" class="elsevierStylePara elsevierViewall">The duration of anticoagulant treatment should be established 3&#8211;6 months after the start of VTE treatment&#44; based on the balance among bleeding risk&#44; the risk of recurrence&#44; and the patient preferences&#46; If there is a high risk of bleeding&#44; discontinuation of anticoagulation should be considered after three months of treatment&#46; If the risk of bleeding is low&#44; the risk of recurrence should be established&#46; The RFs for the development of VTE are determinants for recurrence&#46; Chronic anticoagulation is recommended when the risk of recurrence is &#62;5&#37; per year&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions of the document &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;</span><p id="par0255" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Discontinuation of anticoagulation is recommended three months after a first episode of VTE caused by a resolved major transient RF&#44; if the patient is asymptomatic&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Indefinite anticoagulant treatment is recommended in VTE caused by major permanent RFs &#40;active cancer&#44; antiphospholipid syndrome&#44; among others&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Indefinite anticoagulation is recommended in men with unprovoked VTE&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0275" class="elsevierStylePara elsevierViewall">It is suggested to use additional tools such as the clinical characteristics&#44; DD determination&#44; the HERDOO2 predictive scale&#44; and the study of thrombophilia to assess the risk of recurrence and decide on the optimal duration of anticoagulant treatment in&#58;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a></p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">o</span><p id="par0280" class="elsevierStylePara elsevierViewall">Women with unprovoked VTE&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">o</span><p id="par0285" class="elsevierStylePara elsevierViewall">VTE provoked by a resolved minor transient RF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">o</span><p id="par0290" class="elsevierStylePara elsevierViewall">Patients who wish to discontinue anticoagulation when the event was unprovoked or associated with a permanent RF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">o</span><p id="par0295" class="elsevierStylePara elsevierViewall">Patients with an uncertain risk&#47;benefit balance for indefinite anticoagulant therapy &#40;males with unprovoked VTE and high risk of bleeding&#41;&#46;</p></li></ul></p><p id="par0300" class="elsevierStylePara elsevierViewall">Chronic anticoagulation is recommended in patients with recurrent&#44; unprovoked VTE&#46; In patients with recurrent VTE provoked by a major RF&#44; anticoagulant treatment may be discontinued after completing three months from the second episode&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">Secondary prophylaxis with DOACs versus VKAs is recommended&#44; except in&#58; 1&#41; patients with APS&#44; particularly if triple-positive or with arterial events&#59; and 2&#41; patients with renal failure presenting creatinine clearance &#60;15&#8239;ml&#47;min&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">In patients with chronic anticoagulation criteria&#44; reduced doses of rivaroxaban &#40;10&#8239;mg every 24&#8239;h&#41; or apixaban &#40;2&#46;5&#8239;mg every 12&#8239;h&#41; are preferred&#44; starting at 6 months&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">The indication for anticoagulant therapy should be re-evaluated periodically&#44; considering the balance between risk of recurrence and bleeding&#46; In addition&#44; treatment adherence should be considered&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">As a main limitation of this document&#44; the group developing the recommendations is not multidisciplinary&#44; and the suggestions do not include a cost-benefit analysis &#8212; a factor that healthcare professionals need to evaluate in decision-making&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Compliance with ethical guidelines</span><p id="par0325" class="elsevierStylePara elsevierViewall">This article is based on previously conducted studies and does not contain any new studies with human or animal participants conducted by any of the authors&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0330" class="elsevierStylePara elsevierViewall">No funding has been received&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Expert committee members &#40;Working Group on Venous Thromboembolic Disease of the SEMI&#41;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Mar&#237;a &#193;ngeles Fidalgo&#44; Olga Madridano Cobo&#44; Cristina S&#225;nchez del Hoyo&#44; Javier Mart&#237;n Guerra&#44; Gabriel Puche Palao&#44; Nuria Ruiz-Gim&#233;nez&#44; Carme Font&#44; Javier Pag&#225;n Escribano&#44; Maria Ortiz and Alberto Rodr&#237;guez Iglesias&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Uncited references</span><p id="par0340" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#bib0250">&#91;50&#44;72&#93;</a>&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres2271487"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1893386"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2271488"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1893385"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results and recommendations"
          "secciones" => array:7 [
            0 => array:3 [
              "identificador" => "sec0020"
              "titulo" => "Risk factors for recurrence in unprovoked VTE"
              "secciones" => array:10 [
                0 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "1&#46; Presentation of the event"
                ]
                1 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "2&#46; D-dimer"
                ]
                2 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "3&#46; Obesity"
                ]
                3 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "4&#46; Inflammatory bowel disease"
                ]
                4 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "5&#46; Thrombophilia"
                ]
                5 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "6&#46; Aging and sex"
                ]
                6 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "7&#46; Residual venous occlusion"
                ]
                7 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "8&#46; Post-thrombotic syndrome"
                ]
                8 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "9&#46; Antipsychotic drugs"
                ]
                9 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "10&#46; Recurrence risk scales in venous thromboembolic disease"
                ]
              ]
            ]
            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Prediction of bleeding risk"
            ]
            2 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Follow-up of VTE and complications"
            ]
            3 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Chronic complications after PE"
            ]
            4 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Post-thrombotic syndrome of the lower limbs"
            ]
            5 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Extended anticoagulant therapy"
            ]
            6 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "Clinical guide recommendations for extended anticoagulant therapy"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Conclusions of the document &#40;Figs&#46; 1 and 2&#41;"
        ]
        8 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Compliance with ethical guidelines"
        ]
        9 => array:2 [
          "identificador" => "sec0115"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0120"
          "titulo" => "Expert committee members &#40;Working Group on Venous Thromboembolic Disease of the SEMI&#41;"
        ]
        11 => array:2 [
          "identificador" => "sec0125"
          "titulo" => "Uncited references"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-06-29"
    "fechaAceptado" => "2024-07-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1893386"
          "palabras" => array:7 [
            0 => "Anticoagulation"
            1 => "Deep vein thrombosis"
            2 => "Hemorrhagic risk scores"
            3 => "Post-pulmonary embolism syndrome"
            4 => "Pulmonary embolism"
            5 => "Recurrence"
            6 => "Venous thromboembolism"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1893385"
          "palabras" => array:7 [
            0 => "Anticoagulaci&#243;n"
            1 => "Embolia de pulm&#243;n"
            2 => "Enfermedad tromboemb&#243;lica venosa"
            3 => "Escalas de riesgo hemorr&#225;gico"
            4 => "Recurrencia"
            5 => "S&#237;ndrome postembolia de pulm&#243;n"
            6 => "Trombosis venosa profunda"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Venous thromboembolim &#40;VTE&#41; is a highly prevalent condition that requires long-term monitoring and treatment&#46; This monitoring includes&#58; 1&#41; completing the etiological study and determining the risk of VTE recurrence&#59; 2&#41; establishing the optimal duration of anticoagulant treatment&#44; as well as the type of therapy and its dosage&#59; 3&#41; estimating the risk of bleeding&#44; and 4&#41; identifying the occurrence of chronic complications&#46; This consensus document&#44; prepared by the VTE Group of the Spanish Society of Internal Medicine &#40;SEMI&#41;&#44; aims to update and establish consensus recommendations on these aspects&#46; The document focuses on four aspects of management&#58; the first includes risk factors for VTE recurrence after an unprovoked VTE episode and describes the predictive scores of VTE recurrence&#59; the second focuses on risk factors for bleeding&#59; the third provides recommendations for long-term follow-up in VTE&#44; addressing specific considerations for screening chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome of the lower limbs&#59; and the fourth provides guidance on the optimal duration of extended anticoagulant treatment&#44; as well as the type of therapy and its dosage&#46; For each area&#44; an exhaustive literature review was conducted&#44; analyzing the updated VTE clinical guidelines and recent studies&#46; This document is intended to be a guide in the long-term management of VTE based on the most current knowledge&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La enfermedad tromboemb&#243;lica venosa &#40;ETV&#41; es una enfermedad altamente prevalente&#44; que requiere de seguimiento y tratamiento extendidos&#46; Este seguimiento implica diversos aspectos clave&#58; 1&#41; completar el estudio etiol&#243;gico y determinar el riesgo de recurrencia de futuros eventos tromboemb&#243;licos&#59; 2&#41; establecer la duraci&#243;n &#243;ptima del tratamiento anticoagulante&#44; as&#237; como el tipo de terapia y su dosis&#59; 3&#41; estimar el riesgo de hemorragia&#44; y 4&#41; identificar la posible aparici&#243;n de complicaciones cr&#243;nicas&#46; El presente documento&#44; elaborado por el Grupo de Enfermedad Tromboemb&#243;lica de la Sociedad Espa&#241;ola de Medicina Interna&#44; pretende actualizar y establecer recomendaciones sobre estos aspectos&#46; El documento se centra en 4 aspectos del manejo&#58; el primero incluye los factores de riesgo de recurrencia en la ETV no provocada y las escalas predictivas de recurrencia&#59; el segundo se centra en los factores predictores de hemorragia&#59; el tercero ofrece recomendaciones sobre el seguimiento a largo plazo en la ETV y aborda consideraciones espec&#237;ficas para el despistaje de la hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica y del s&#237;ndrome postromb&#243;tico&#59; y el cuarto brinda orientaci&#243;n sobre la duraci&#243;n &#243;ptima del tratamiento anticoagulante extendido&#44; as&#237; como el tipo de terapia y su dosis&#46; Para cada &#225;rea se realiz&#243; una exhaustiva revisi&#243;n bibliogr&#225;fica analizando diferentes gu&#237;as cl&#237;nicas de la ETV y estudios recientes que han valorado los aspectos tratados en el art&#237;culo&#46; El objetivo del documento es que sirva de ayuda en el manejo de la ETV a largo plazo basado en el conocimiento m&#225;s actual&#46;</p></span>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0355" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0135"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 4425
            "Ancho" => 2435
            "Tamanyo" => 1296107
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Long-term treatment of venous thromboembolic disease&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 4425
            "Ancho" => 2430
            "Tamanyo" => 1362070
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Follow-up of venous thromboembolic disease and complications&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 4425
            "Ancho" => 2425
            "Tamanyo" => 1225661
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dosage&#46;</p>"
        ]
      ]
      3 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.docx"
          "ficheroTamanyo" => 327477
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:74 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antithrombotic therapy for VTE disease&#58; CHEST Guideline and Expert Panel report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Kearon"
                            1 => "E&#46;A&#46; Akl"
                            2 => "J&#46; Ornelas"
                            3 => "A&#46; Blaivas"
                            4 => "D&#46; Jimenez"
                            5 => "H&#46; Bounameaux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.chest.2015.11.026"
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2016"
                        "volumen" => "149"
                        "paginaInicial" => "315"
                        "paginaFinal" => "352"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antithrombotic therapy for VTE disease&#58; second update of the CHEST guideline and Expert Panel report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Stevens"
                            1 => "S&#46;C&#46; Woller"
                            2 => "L&#46;B&#46; Kreuziger"
                            3 => "H&#46; Bounameaux"
                            4 => "K&#46; Doerschug"
                            5 => "G&#46;J&#46; Geersing"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.chest.2021.07.055"
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2021"
                        "volumen" => "160"
                        "paginaInicial" => "e545"
                        "paginaFinal" => "e608"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology &#40;ESC&#41;&#46; 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society &#40;ERS&#41;&#58; the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;V&#46; Konstantinides"
                            1 => "G&#46; Meyer"
                            2 => "C&#46; Becattini"
                            3 => "H&#46; Bueno"
                            4 => "G&#46;J&#46; Geersing"
                            5 => "V&#46;P&#46; Harjola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/13993003.01647-2019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2019"
                        "volumen" => "54"
                        "paginaInicial" => "1901647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31473594"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1535610821006048"
                          "estado" => "S300"
                          "issn" => "15356108"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anticoagulation for patients with venous thromboembolism&#58; when is extended treatment required&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;I&#46; Weitz"
                            1 => "P&#46; Prandoni"
                            2 => "P&#46; Verhamme"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0040-1721735"
                      "Revista" => array:6 [
                        "tituloSerie" => "TH Open"
                        "fecha" => "2020"
                        "volumen" => "4"
                        "paginaInicial" => "e446"
                        "paginaFinal" => "e456"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33376944"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish consensus for the management of pulmonary thromboembolism"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "en nombre de los autores del Consenso"
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Lobo"
                            1 => "D&#46; Jim&#233;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2021.04.023"
                      "Revista" => array:2 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2021"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary embolism&#58; update on management and controversies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Duffett"
                            1 => "L&#46;A&#46; Castellucci"
                            2 => "M&#46;A&#46; Forgie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.m2177"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2020"
                        "volumen" => "370"
                        "paginaInicial" => "m2177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32759284"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American Society of Hematology 2020 guidelines for management of venous thromboembolism&#58; treatment of deep vein thrombosis and pulmonary embolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;L&#46; Ortel"
                            1 => "I&#46; Neumann"
                            2 => "W&#46; Ageno"
                            3 => "R&#46; Beyth"
                            4 => "N&#46;P&#46; Clark"
                            5 => "A&#46; Cuker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/bloodadvances.2020001830"
                      "Revista" => array:5 [
                        "tituloSerie" => "Blood Adv"
                        "fecha" => "2020"
                        "volumen" => "4"
                        "paginaInicial" => "4693"
                        "paginaFinal" => "4738"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Who should get long-term anticoagulant therapy for venous thromboembolism and with what&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;A&#46; Rodger"
                            1 => "G&#46; Le Gal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/bloodadvances.2018020230"
                      "Revista" => array:5 [
                        "tituloSerie" => "Blood Adv"
                        "fecha" => "2018"
                        "volumen" => "2"
                        "paginaInicial" => "3081"
                        "paginaFinal" => "3087"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subcommittee on Control of Anticoagulation of the SSC of the ISTH&#46; Risk of recurrent venous thromboembolism after stopping treatment in cohort studies&#58; recommendation for acceptable rates and standardized reporting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Kearon"
                            1 => "A&#46; Iorio"
                            2 => "G&#46; Palareti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1538-7836.2010.03991"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2010"
                        "volumen" => "8"
                        "paginaInicial" => "2313"
                        "paginaFinal" => "2315"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MARVELOUS Collaborators&#46; Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Khan"
                            1 => "A&#46; Rahman"
                            2 => "M&#46; Carrier"
                            3 => "C&#46; Kearon"
                            4 => "J&#46;I&#46; Weitz"
                            5 => "S&#46; Schulman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.l4363"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2019"
                        "volumen" => "366"
                        "paginaInicial" => "l4363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31340984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment&#58; analysis of individual participants data from seven trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Boutitie"
                            1 => "L&#46; Pinede"
                            2 => "S&#46; Schulman"
                            3 => "G&#46; Agnelli"
                            4 => "G&#46; Raskob"
                            5 => "J&#46; Julian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.d3036"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2011"
                        "volumen" => "342"
                        "paginaInicial" => "d3036"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PROLONG Investigators&#46; D-dimer testing to determine the duration of anticoagulation therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Palareti"
                            1 => "B&#46; Cosmi"
                            2 => "C&#46; Legnani"
                            3 => "A&#46; Tosetto"
                            4 => "C&#46; Brusi"
                            5 => "A&#46; Iorio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa054444"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "355"
                        "paginaInicial" => "1780"
                        "paginaFinal" => "1789"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17065639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A test in context&#58; D-dimer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;I&#46; Weitz"
                            1 => "J&#46;C&#46; Fredenburgh"
                            2 => "J&#46;W&#46; Eikelboom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2017.09.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2017"
                        "volumen" => "70"
                        "paginaInicial" => "2411"
                        "paginaFinal" => "2420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29096812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-level meta-analysis&#58; effect of measurement timing&#44; threshold&#44; and patient age on ability of D-dimer testing to assess recurrence risk after unprovoked venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Douketis"
                            1 => "A&#46; Tosetto"
                            2 => "M&#46; Marcucci"
                            3 => "T&#46; Baglin"
                            4 => "M&#46; Cushman"
                            5 => "S&#46; Eichinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-153-8-201010190-00009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2010"
                        "volumen" => "153"
                        "paginaInicial" => "523"
                        "paginaFinal" => "531"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956709"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review&#58; D-dimer to predict recurrent disease after stopping anticoagulant therapy for unprovoked venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Verhovsek"
                            1 => "J&#46;D&#46; Douketis"
                            2 => "Q&#46; Yi"
                            3 => "S&#46; Shrivastava"
                            4 => "R&#46;C&#46; Tait"
                            5 => "T&#46; Baglin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-149-7-200810070-00008"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2008"
                        "volumen" => "149"
                        "paginaInicial" => "481"
                        "paginaFinal" => "490"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18838728"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2405471220301952"
                          "estado" => "S300"
                          "issn" => "24054712"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of D-Dimer testing for recurrent venous thromboembolism&#58; a systematic review with meta-analysis&#46;&#58; VTE recurrence and D-dimer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;N&#46;D&#46; Di Minno"
                            1 => "I&#46; Calcaterra"
                            2 => "A&#46; Papa"
                            3 => "R&#46; Lupoli"
                            4 => "A&#46; Di Minno"
                            5 => "M&#46; Maniscalco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2021.04.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Intern Med"
                        "fecha" => "2021"
                        "volumen" => "89"
                        "paginaInicial" => "39"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33933338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "DULCIS &#40;D-dimer and ULtrasonography in Combination Italian Study&#41; Investigators&#46; D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism&#58; a management study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Palareti"
                            1 => "B&#46; Cosmi"
                            2 => "C&#46; Legnani"
                            3 => "E&#46; Antonucci"
                            4 => "V&#46; de Micheli"
                            5 => "A&#46; Ghirarduzzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11739-019-02216-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2014"
                        "volumen" => "124"
                        "paginaInicial" => "196"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24879813"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to d-dimer results&#59; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Kearon"
                            1 => "S&#46; Parpia"
                            2 => "F&#46;A&#46; Spencer"
                            3 => "S&#46; Schulman"
                            4 => "S&#46;M&#46; Stevens"
                            5 => "V&#46; Shah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jth.14458"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2019"
                        "volumen" => "17"
                        "paginaInicial" => "1144"
                        "paginaFinal" => "1152"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Morgagni Investigators&#46; Residual vein thrombosis and serial D-dimer for the long-term management of patients with deep venous thrombosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Prandoni"
                            1 => "V&#46; Vedovetto"
                            2 => "M&#46; Ciammaichella"
                            3 => "E&#46; Bucherini"
                            4 => "S&#46; Corradini"
                            5 => "I&#46; Enea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.thromres.2017.04.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thromb Res"
                        "fecha" => "2017"
                        "volumen" => "154"
                        "paginaInicial" => "35"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28407492"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-vitamin K anticoagulants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Legnani"
                            1 => "I&#46; Martinelli"
                            2 => "G&#46; Palareti"
                            3 => "A&#46; Ciavarella"
                            4 => "D&#46; Poli"
                            5 => "W&#46; Ageno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0219751"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2019"
                        "volumen" => "14"
                        "paginaInicial" => "e0219751"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31310608"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "D-dimer and reduced-dose apixaban for extended treatment after unprovoked venous thromboembolism&#58; the Apidulcis study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Palareti"
                            1 => "D&#46; Poli"
                            2 => "W&#46; Ageno"
                            3 => "C&#46; Legnani"
                            4 => "E&#46; Antonucci"
                            5 => "E&#46; Bucherini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/bloodadvances.2022007973"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Adv"
                        "fecha" => "2022"
                        "volumen" => "6"
                        "paginaInicial" => "6005"
                        "paginaFinal" => "6015"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35914222"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Overweight&#44; obesity&#44; and the risk of recurrent venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Eichinger"
                            1 => "G&#46; Hron"
                            2 => "C&#46; Bialonczyk"
                            3 => "M&#46; Hirschl"
                            4 => "E&#46; Minar"
                            5 => "O&#46; Wagner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinte.168.15.1678"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2008"
                        "volumen" => "168"
                        "paginaInicial" => "1678"
                        "paginaFinal" => "1683"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recurrent venous thrombosis related to overweight and obesity&#58; results from the MEGA follow-up study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;A&#46; Vu&#269;kovi&#263;"
                            1 => "S&#46;C&#46; Cannegieter"
                            2 => "A&#46; van Hylckama Vlieg"
                            3 => "F&#46;R&#46; Rosendaal"
                            4 => "W&#46;M&#46; Lijfering"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jth.13710"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2017"
                        "volumen" => "15"
                        "paginaInicial" => "1430"
                        "paginaFinal" => "1435"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28439955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous and arterial thromboembolism in patients with inflammatory bowel diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Stadnicki"
                            1 => "I&#46; Stadnicka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.v27.i40.6757"
                      "Revista" => array:5 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2021"
                        "volumen" => "27"
                        "paginaInicial" => "6757"
                        "paginaFinal" => "6774"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thromboembolic events in patients with inflammatory bowel disease&#58; a comprehensive overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Gala"
                            1 => "T&#46; Newsome"
                            2 => "N&#46; Roberson"
                            3 => "S&#46;M&#46; Lee"
                            4 => "M&#46; Thekkanal"
                            5 => "M&#46; Shah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/diseases10040073"
                      "Revista" => array:4 [
                        "tituloSerie" => "Diseases"
                        "fecha" => "2022"
                        "volumen" => "10"
                        "paginaInicial" => "73"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective cohort study on the absolute risks of venous thromboembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S&#44; protein C or antithrombin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;K&#46; Mahmoodi"
                            1 => "J&#46;L&#46; Brouwer"
                            2 => "M&#46;K&#46; Ten Kate"
                            3 => "W&#46;M&#46; Lijfering"
                            4 => "N&#46;J&#46;G&#46;M&#46; Veeger"
                            5 => "A&#46;B&#46; Mulder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1538-7836.2010.03840.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2010"
                        "volumen" => "8"
                        "paginaInicial" => "1193"
                        "paginaFinal" => "1200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20230415"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Selective testing for thrombophilia in patients with first venous thrombosis&#58; results from a retrospective family cohort study on absolute thrombotic risk for currently known thrombophilic defects in 2479 relatives"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;M&#46; Lijfering"
                            1 => "J&#46;-L&#46;P&#46; Brouwer"
                            2 => "N&#46;J&#46; Veeger"
                            3 => "I&#46; Bank"
                            4 => "M&#46; Coppens"
                            5 => "S&#46; Middeldorp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2008-10-184879"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2009"
                        "volumen" => "113"
                        "paginaInicial" => "5314"
                        "paginaFinal" => "5322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19139080"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACR&#47;EULAR APS Classification Criteria Collaborators&#46; The 2023 ACR&#47;EULAR antiphospholipid syndrome classification criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Barbhaiya"
                            1 => "S&#46; Zuily"
                            2 => "R&#46; Naden"
                            3 => "A&#46; Hendry"
                            4 => "F&#46; Manneville"
                            5 => "M&#46;C&#46; Amigo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard-2023-224609"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Rheumatol"
                        "fecha" => "2023"
                        "volumen" => "75"
                        "paginaInicial" => "1687"
                        "paginaFinal" => "1702"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;A&#46; Heit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrcardio.2015.83"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Cardiol"
                        "fecha" => "2015"
                        "volumen" => "12"
                        "paginaInicial" => "464"
                        "paginaFinal" => "474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26076949"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of recurrence after venous throm-boembolism in men and women&#58; patient level meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Douketis"
                            1 => "A&#46; Tosetto"
                            2 => "M&#46; Marcucci"
                            3 => "T&#46; Baglin"
                            4 => "B&#46; Cosmi"
                            5 => "M&#46; Cushman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.d813"
                      "Revista" => array:4 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "2011"
                        "volumen" => "342"
                        "paginaInicial" => "d813"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Residual vein obstruction to predict the risk of recurrent venous thromboembolism in patients with deep vein thrombosis&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Carrier"
                            1 => "M&#46;A&#46; Rodger"
                            2 => "P&#46;S&#46; Wells"
                            3 => "M&#46; Righini"
                            4 => "G&#46;L&#46;E&#46; Gal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1538-7836.2011.04254.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2011"
                        "volumen" => "9"
                        "paginaInicial" => "1119"
                        "paginaFinal" => "1125"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Residual vein obstruction as a predictor for recurrent thromboembolic events after a first unprovoked episode&#58; data from the REVERSE cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Le Gal"
                            1 => "M&#46; Carrier"
                            2 => "M&#46;J&#46; Kovacs"
                            3 => "M&#46;T&#46; Betancourt"
                            4 => "S&#46;R&#46; Kahn"
                            5 => "P&#46;S&#46; Wells"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1538-7836.2011.04240.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2011"
                        "volumen" => "9"
                        "paginaInicial" => "1126"
                        "paginaFinal" => "1132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21324057"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism&#58; a systematic review and meta-analysis of individual participant data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Robin"
                            1 => "R&#46; Le Pennec"
                            2 => "M&#46; Eddy"
                            3 => "L&#46; Sikora"
                            4 => "P&#46;-Y&#46; Le Roux"
                            5 => "M&#46; Carrier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtha.2023.01.030"
                      "Revista" => array:2 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2023"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The post-thrombotic syndrome&#58; risk factors and impact on the course of thrombotic disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Stain"
                            1 => "V&#46; Schonauer"
                            2 => "E&#46; Minar"
                            3 => "C&#46; Bialonczyk"
                            4 => "M&#46; Hirschl"
                            5 => "A&#46; Weltermann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1538-7836.2005.01648.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2005"
                        "volumen" => "3"
                        "paginaInicial" => "2671"
                        "paginaFinal" => "2676"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16359506"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous Thromboembolism during treatment with antipsychotics&#58; a review of current evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;K&#46; J&#246;nsson"
                            1 => "J&#46; Schill"
                            2 => "H&#46; Olsson"
                            3 => "O&#46; Spigset"
                            4 => "S&#46; H&#228;gg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40263-018-0495-7"
                      "Revista" => array:7 [
                        "tituloSerie" => "CNS Drugs"
                        "fecha" => "2018"
                        "volumen" => "32"
                        "paginaInicial" => "47"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29423659"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0092867422003439"
                          "estado" => "S300"
                          "issn" => "00928674"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antipsychotic drugs and the risk of recurrent venous thromboembolism&#58; a prospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Mollard"
                            1 => "R&#46; Le Mao"
                            2 => "C&#46; Tromeur"
                            3 => "E&#46; Le Moigne"
                            4 => "M&#46; Gouillou"
                            5 => "B&#46; Pan-Petesch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2018.02.030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Intern Med"
                        "fecha" => "2018"
                        "volumen" => "52"
                        "paginaInicial" => "22"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29548526"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antipsychotic drugs and risk of venous thromboembolism&#58; nested case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Parker"
                            1 => "C&#46; Coupland"
                            2 => "J&#46; Hippisley-Cox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.c4245"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ&#46;"
                        "fecha" => "2010"
                        "volumen" => "341"
                        "paginaInicial" => "c4245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20858909"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Rodger"
                            1 => "S&#46;R&#46; Kahn"
                            2 => "P&#46;S&#46; Wells"
                            3 => "D&#46;A&#46; Anderson"
                            4 => "I&#46; Chagnon"
                            5 => "G&#46; Le Gal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1503/cmaj.080493"
                      "Revista" => array:6 [
                        "tituloSerie" => "CMAJ"
                        "fecha" => "2008"
                        "volumen" => "179"
                        "paginaInicial" => "417"
                        "paginaFinal" => "426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18725614"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting disease recurrence in patients with previous unprovoked venous thromboembolism&#58; a proposed prediction score &#40;DASH&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tosetto"
                            1 => "A&#46; Iorio"
                            2 => "M&#46; Marcucci"
                            3 => "T&#46; Baglin"
                            4 => "M&#46; Cushman"
                            5 => "S&#46; Eichinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1538-7836.2012.04735.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2012"
                        "volumen" => "10"
                        "paginaInicial" => "1019"
                        "paginaFinal" => "1025"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22489957"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism&#58; the Vienna prediction model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Eichinger"
                            1 => "G&#46; Heinze"
                            2 => "L&#46;M&#46; Jandeck"
                            3 => "P&#46;A&#46; Kyrle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.109.925214"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "121"
                        "paginaInicial" => "1630"
                        "paginaFinal" => "1636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20351233"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism &#40;DAMOVES&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;I&#46; Franco Moreno"
                            1 => "M&#46;J&#46; Garc&#237;a Navarro"
                            2 => "J&#46; Ortiz S&#225;nchez"
                            3 => "R&#46;M&#46; Mart&#237;n D&#237;az"
                            4 => "E&#46; Madro&#241;al Cerezo"
                            5 => "C&#46;L&#46; de Ancos Aracil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2015.12.010"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Intern Med"
                        "fecha" => "2016"
                        "volumen" => "29"
                        "paginaInicial" => "59"
                        "paginaFinal" => "64"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "REVERSE II Study Investigators&#46; Validating the HERDOO<span class="elsevierStyleInf">2</span> rule to guide treatment duration for women with unprovoked venous thrombosis&#58; multinational prospective cohort management study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Rodger"
                            1 => "G&#46; Le Gal"
                            2 => "D&#46;R&#46; Anderson"
                            3 => "J&#46; Schmidt"
                            4 => "G&#46; Pernod"
                            5 => "S&#46;R&#46; Kahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.j1065"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2017"
                        "volumen" => "356"
                        "paginaInicial" => "j1065"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28314711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "External validation of the DASH prediction rule&#58; a retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tosetto"
                            1 => "S&#46; Testa"
                            2 => "I&#46; Martinelli"
                            3 => "D&#46; Poli"
                            4 => "B&#46; Cosmi"
                            5 => "C&#46; Lodigiani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jth.13781"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2017"
                        "volumen" => "15"
                        "paginaInicial" => "1963"
                        "paginaFinal" => "1970"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of recurrence after a first unprovoked venous thromboembolism&#58; external validation of the Vienna Prediction Model with pooled individual patient data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Marcucci"
                            1 => "A&#46; Iorio"
                            2 => "J&#46;D&#46; Douketis"
                            3 => "S&#46; Eichinger"
                            4 => "A Tosetto"
                            5 => "T&#46; Baglin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jth.12871"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2015"
                        "volumen" => "13"
                        "paginaInicial" => "775"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25660555"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of bleeding risk in patients who receive anticoagulant therapy for venous thromboembolism&#58; communication from the ISTH SSC Subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;L&#46; Den Exter"
                            1 => "S&#46;C&#46; Woller"
                            2 => "H&#46; Robert-Ebadi"
                            3 => "C&#46; Masias"
                            4 => "P&#46;E&#46; Morange"
                            5 => "D&#46; Castelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jth.15776"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2022"
                        "volumen" => "20"
                        "paginaInicial" => "1910"
                        "paginaFinal" => "1919"
                        "itemHostRev" => array:3 [
                          "pii" => "S1535610820305973"
                          "estado" => "S300"
                          "issn" => "15356108"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting anticoagulant-related bleeding in patients with ve-nous thromboembolism&#58; a clinically oriented review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;A&#46; Klok"
                            1 => "J&#46; Kooiman"
                            2 => "M&#46;V&#46; Huisman"
                            3 => "S&#46; Konstantinides"
                            4 => "M&#46; Lankeit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00040714"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2015"
                        "volumen" => "45"
                        "paginaInicial" => "201"
                        "paginaFinal" => "210"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term risk for major bleeding during extended oral anticoagulant therapy for first un- provoked venous thromboembolism&#58; a systematic review an meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Khan"
                            1 => "T&#46; Tritschler"
                            2 => "M&#46; Kimpton"
                            3 => "P&#46;S&#46; Wells"
                            4 => "C&#46; Kearon"
                            5 => "J&#46;I&#46; Weitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/m21-1094"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Int Med"
                        "fecha" => "2021"
                        "volumen" => "174"
                        "paginaInicial" => "1420"
                        "paginaFinal" => "1429"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive variables for major bleeding events in patients presenting with documented acute venous tromboembolism&#46; Findings from the RIETE Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Ruiz Gim&#233;nez"
                            1 => "C&#46; Su&#225;rez"
                            2 => "R&#46; Gonz&#225;lez"
                            3 => "J&#46;A&#46; Nieto"
                            4 => "J&#46;A&#46; Todol&#237;"
                            5 => "A&#46;L&#46; Samperiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1160/TH08-03-0193"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thromb Haemost"
                        "fecha" => "2008"
                        "volumen" => "100"
                        "paginaInicial" => "26"
                        "paginaFinal" => "31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18612534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of bleeding events in patients with venous thromboembolism on stable anticoagulation treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;A&#46; Klok"
                            1 => "V&#46; H&#246;sel"
                            2 => "A&#46; Clemens"
                            3 => "W&#46;D&#46; Yollo"
                            4 => "C&#46; Tilke"
                            5 => "S&#46; Schulman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/13993003.00280-2016"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2016"
                        "volumen" => "48"
                        "paginaInicial" => "1369"
                        "paginaFinal" => "1376"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term association of venous thromboembolism with frailty&#44; physical functioning&#44; and quality of life&#58; the atherosclerosis risk in communities study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;L&#46; Lutsey"
                            1 => "B&#46;G&#46; Windham"
                            2 => "J&#46;R&#46; Misialek"
                            3 => "M&#46; Cushman"
                            4 => "A&#46; Kucharska-Newton"
                            5 => "S&#46; Basu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/JAHA.119.015656"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Heart Assoc"
                        "fecha" => "2020"
                        "volumen" => "9"
                        "paginaInicial" => "e015656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32476561"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinants and management of the post-pulmonary embolism syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;J&#46;A&#46;M&#46; Boon"
                            1 => "M&#46;V&#46; Huisman"
                            2 => "F&#46;A&#46; Klok"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0041-1722964"
                      "Revista" => array:5 [
                        "tituloSerie" => "Semin Respir Crit Care Med"
                        "fecha" => "2021"
                        "volumen" => "42"
                        "paginaInicial" => "299"
                        "paginaFinal" => "307"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The post-PE syndrome&#58; a new concept for chronic complications of pulmonary embolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;A&#46; Klok"
                            1 => "T&#46; van der Hulle"
                            2 => "P&#46;L&#46; den Exter"
                            3 => "M&#46; Lankeit"
                            4 => "M&#46;V&#46; Huisman"
                            5 => "S&#46; Konstantinides"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.blre.2014.07.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Rev"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "221"
                        "paginaFinal" => "226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25168205"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measuring functional limitations after venous thromboembolism&#58; optimization of the Post-VTE Functional Status &#40;PVFS&#41; scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Boon"
                            1 => "S&#46; Barco"
                            2 => "L&#46; Bertoletti"
                            3 => "W&#46; Ghanima"
                            4 => "M&#46;V&#46; Huisman"
                            5 => "S&#46;R&#46; Kahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.thromres.2020.03.020"
                      "Revista" => array:5 [
                        "tituloSerie" => "Thromb Res"
                        "fecha" => "2020"
                        "volumen" => "190"
                        "paginaInicial" => "45"
                        "paginaFinal" => "51"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimal follow-up after acute pulmonary embolism&#58; a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function&#44; in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology&#44; endorsed by the European Respiratory Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;A&#46; Klok"
                            1 => "W&#46; Ageno"
                            2 => "C&#46; Ay"
                            3 => "M&#46; B&#228;ck"
                            4 => "S&#46; Barco"
                            5 => "L&#46; Bertoletti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehab816"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2022"
                        "volumen" => "43"
                        "paginaInicial" => "183"
                        "paginaFinal" => "189"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary chronic thromboembolic disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Ram&#237;rez"
                            1 => "R&#46; Otero"
                            2 => "J&#46;A&#46; Barber&#224;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbr.2020.03.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2020"
                        "volumen" => "56"
                        "paginaInicial" => "314"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35373741"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC&#47;ERS Scientific Document Group&#46; 2022 ESC&#47;ERS Guidelines for the diagnosis and treatment of pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Humbert"
                            1 => "G&#46; Kovacs"
                            2 => "M&#46;M&#46; Hoeper"
                            3 => "R&#46; Badagliacca"
                            4 => "R&#46;M&#46;F&#46; Berger"
                            5 => "M&#46; Brida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehac237"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2022"
                        "volumen" => "43"
                        "paginaInicial" => "3618"
                        "paginaFinal" => "3731"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36017548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of oral anticoagulant drugs in patients with pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Demelo-Rodriguez"
                            1 => "F&#46; Galeano-Valle"
                            2 => "M&#46; Proietti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hfc.2022.08.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Fail Clin"
                        "fecha" => "2023"
                        "volumen" => "19"
                        "paginaInicial" => "97"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36435577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The post-thrombotic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;R&#46; Kahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/asheducation-2016.1.413"
                      "Revista" => array:5 [
                        "tituloSerie" => "Hematology Am Soc Hematol Educ Program&#46;"
                        "fecha" => "2016"
                        "volumen" => "2016"
                        "paginaInicial" => "413"
                        "paginaFinal" => "418"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of the post-thrombotic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Galanaud"
                            1 => "M&#46; Monreal"
                            2 => "S&#46;R&#46; Kahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.thromres.2017.07.026"
                      "Revista" => array:5 [
                        "tituloSerie" => "Thromb Res"
                        "fecha" => "2018"
                        "volumen" => "164"
                        "paginaInicial" => "100"
                        "paginaFinal" => "109"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European Society of Vascular Medicine &#40;ESVM&#41;&#46; Post-thrombotic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Vison&#224;"
                            1 => "I&#46; Quere"
                            2 => "L&#46; Mazzolai"
                            3 => "M&#46; Amitrano"
                            4 => "M&#46; Lugli"
                            5 => "J&#46; Madaric"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1024/0301-1526/a000946"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vasa"
                        "fecha" => "2021"
                        "volumen" => "50"
                        "paginaInicial" => "331"
                        "paginaFinal" => "340"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33720757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound for lower extremity deep venous thrombosis&#58; multidisciplinary recommendations from the society of radiologists in ultrasound consensus conference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Needleman"
                            1 => "J&#46;J&#46; Cronan"
                            2 => "M&#46;P&#46; Lilly"
                            3 => "G&#46;J&#46; Merli"
                            4 => "S&#46; Adhikari"
                            5 => "B&#46;S&#46; Hertzberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.117.030687"
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2018"
                        "volumen" => "137"
                        "paginaInicial" => "1505"
                        "paginaFinal" => "1515"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism&#58; evidence from phase 3 trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Van Es"
                            1 => "M&#46; Coppens"
                            2 => "S&#46; Schulman"
                            3 => "S&#46; Middeldorp"
                            4 => "H&#46;R&#46; B&#252;ller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2014-04-571232"
                      "Revista" => array:5 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2014"
                        "volumen" => "124"
                        "paginaInicial" => "1968"
                        "paginaFinal" => "1975"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extended use of dabigatran&#44; warfarin&#44; or placebo in venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Chulman"
                            1 => "C&#46; Kearon"
                            2 => "A&#46;K&#46; Kakkar"
                            3 => "S&#46; Schellong"
                            4 => "H&#46; Eriksson"
                            5 => "D&#46; Baanstra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1113697"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "709"
                        "paginaFinal" => "718"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23425163"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral rivaroxaban for symptomatic venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Bauersachs"
                            1 => "S&#46;D&#46; Berkowitz"
                            2 => "B&#46; Brenner"
                            3 => "H&#46;R&#46; Buller"
                            4 => "H&#46; Decousus"
                            5 => "A&#46;S&#46; Gallus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1007903"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "363"
                        "paginaInicial" => "2499"
                        "paginaFinal" => "2510"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21128814"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rivaroxaban or aspirin for extended treatment of venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;I&#46; Weitz"
                            1 => "A&#46;W&#46;A&#46; Lensing"
                            2 => "M&#46;H&#46; Prins"
                            3 => "R&#46; Bauersachs"
                            4 => "J&#46; Beyer-Westendorf"
                             …1
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1700518"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2017"
                        "volumen" => "376"
                        "paginaInicial" => "1211"
                        "paginaFinal" => "1222"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extended duration of anticoagulation with edoxaban in patients with venous thromboembolism&#58; a post hoc analysis of the Hokusai-VTE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2352-3026(16)00023-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Haematol"
                        "fecha" => "2016"
                        "volumen" => "3"
                        "paginaInicial" => "e228"
                        "paginaFinal" => "e236"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AMPLIFY Investigators&#46; Oral apixaban for the treatment of acute venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1302507"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "799"
                        "paginaFinal" => "808"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness and safety of nonvitamin K oral anticoagulants rivaroxaban and apixaban in patients with venous thromboembolism&#58; a meta-analysis of real-world studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2022/2756682"
                      "Revista" => array:4 [
                        "tituloSerie" => "Cardiovasc Ther"
                        "fecha" => "2022"
                        "volumen" => "2022"
                        "paginaInicial" => "2756682"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ASPIRE Investigators&#46; Low-dose aspirin for preventing recurrent venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1210384"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "367"
                        "paginaInicial" => "1979"
                        "paginaFinal" => "1987"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin for preventing the recurrence of venous thromboembolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1114238"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "1959"
                        "paginaFinal" => "1967"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sulodexide for the prevention of recurrent venous thromboembolism&#58; the Sulodexide in Secondary Prevention of Recurrent Deep Vein Thrombosis &#40;SURVET&#41; study&#58; a multicenter&#44; randomized&#44; double-blind&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.115.016930"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2015"
                        "volumen" => "132"
                        "paginaInicial" => "1891"
                        "paginaFinal" => "1897"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short-term versus extended anticoagulant treatment for unprovoked venous thromboembolism&#58; a survey on guideline adherence and physicians&#8217; considerations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.thromres.2019.10.003"
                      "Revista" => array:5 [
                        "tituloSerie" => "Thromb Res"
                        "fecha" => "2019"
                        "volumen" => "183"
                        "paginaInicial" => "49"
                        "paginaFinal" => "55"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extended anticoagulation for VTE&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.chest.2019.02.402"
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2019"
                        "volumen" => "155"
                        "paginaInicial" => "1199"
                        "paginaFinal" => "1216"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second consensus document on diagnosis and management of acute deep vein thrombosis&#58; updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjpc/zwab088"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Prev Cardiol"
                        "fecha" => "2022"
                        "volumen" => "29"
                        "paginaInicial" => "1248"
                        "paginaFinal" => "1263"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/unassign/S2254887424001280/v1_202410160423/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/22548874/unassign/S2254887424001280/v1_202410160423/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887424001280?idApp=WRCEE"
]

Indexed in:

Follow us:

Subscribe:

Article

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter