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Este aumento de manifestaciones tromb&#243;ticas pulmonares se ha descrito en autopsias de pacientes infectados en las epidemias por los coronavirus SARS-CoV y MERS-CoV en 2003 y 2012&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La fisiopatolog&#237;a que relaciona el TEP con la infecci&#243;n por SARS-CoV-2 no se conoce bien y parece estar relacionada con un estado de hipercoagulabilidad&#46; Estudios recientes han demostrado que niveles de d&#237;mero D superiores a 1&#46;000 ng&#47;ml en pacientes con COVID-19 constituyen un &#237;ndice pron&#243;stico relevante de mortalidad<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; La respuesta inflamatoria sist&#233;mica y el da&#241;o endotelial asociados a la infecci&#243;n v&#237;rica activar&#237;an la coagulaci&#243;n&#44; con aumento de la generaci&#243;n de trombina y disminuci&#243;n de los anticoagulantes naturales del organismo&#46; Hace a&#241;os se acu&#241;&#243; esta interrelaci&#243;n entre el sistema inmune y el sistema de coagulaci&#243;n como respuesta a una infecci&#243;n para evitar su propagaci&#243;n con el t&#233;rmino &#171;inmunotrombosis&#187;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El SARS-CoV-2 penetra en las c&#233;lulas epiteliales alveolares a trav&#233;s del receptor de superficie de la enzima convertidora de la angiotensina 2 &#40;ACE2&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; La replicaci&#243;n viral desencadena la activaci&#243;n del complemento&#44; con formaci&#243;n de C3a y C5a&#44; capaces de reclutar neutr&#243;filos&#44; macr&#243;fagos&#44; linfocitos y monocitos&#44; responsables a su vez de la liberaci&#243;n masiva de citoquinas proinflamatorias &#40;IL-1&#44; IL-6&#44; IL-8 e interfer&#243;n-&#947;&#41; que favorecen la expresi&#243;n del factor tisular &#40;FT&#41; de trombomodulina y de mol&#233;culas de adhesi&#243;n endotelial&#44; y activan la fibrin&#243;lisis&#44; entre otros<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; el SARS-CoV-2 infecta las c&#233;lulas endoteliales que expresan ACE2&#46; Este da&#241;o endotelial activa el FT&#44; que genera trombina a partir de la protrombina por acci&#243;n del factor X activado&#59; las plaquetas circulantes activadas se agregan y proporcionan la superficie fosfolip&#237;dica adecuada para la adhesi&#243;n de los diferentes compuestos de la cascada de la coagulaci&#243;n con la generaci&#243;n de gran cantidad de trombina&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recientemente&#44; Ciceri et al&#46; han propuesto el acr&#243;nimo MicroCLOTS <span class="elsevierStyleItalic">&#40;microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome&#41;</span> para designar esta microangiopat&#237;a tromb&#243;tica pulmonar o trombosis <span class="elsevierStyleItalic">in situ</span><a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#46; Concordante con esta hip&#243;tesis fisiopatol&#243;gica se han hallado en las autopsias de pacientes fallecidos por COVID-19 trombos&#160;de fibrina en vasos arteriales pulmonares de peque&#241;o tama&#241;o<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Por ello parece interesante conocer la incidencia de trombosis venosa profunda &#40;TVP&#41; en pacientes con COVID-19 y TEP&#46; Seg&#250;n las series&#44; en pacientes con TEP la presencia de TVP concomitante var&#237;a entre un 35-45&#37;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46; Aunque el 20&#37; de pacientes con TEP pueden presentar TVP no diagnosticada&#44; los estudios de Poissy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> y Lodigiani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> observaron una incidencia de TVP del 13&#44;6 y 10&#37;&#44; respectivamente&#44; en pacientes con COVID-19 y TEP&#46; Las series de casos de pacientes con COVID-19 y TEV publicadas se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la insuficiencia respiratoria grave que desarrollan los pacientes con COVID-19 podr&#237;a explicarse en parte por una microangiopat&#237;a tromb&#243;tica pulmonar consecuencia de una respuesta inmune exagerada del hu&#233;sped&#46; La coagulopat&#237;a presente en estos pacientes ha promovido que se planteen diferentes estrategias antitromb&#243;ticas&#44; especialmente en pacientes graves ingresados en unidades de cuidados intensivos &#40;UCI&#41;&#46; Aunque no conocemos la mejor estrategia antitromb&#243;tica&#44; las heparinas de bajo peso molecular a dosis profil&#225;cticas o dosis intermedias deber&#237;an indicarse en estos pacientes &#40;salvo contraindicaci&#243;n&#41;&#44; reserv&#225;ndose la anticoagulaci&#243;n terap&#233;utica para los casos en los que se objetive o se sospeche una trombosis<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se necesitan ensayos&#160;controlados aleatorios para determinar la idoneidad de la tromboprofilaxis primaria m&#225;s all&#225; del alta hospitalaria y el tiempo &#243;ptimo de tratamiento anticoagulante en pacientes con TEP&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R&#233;gimen de terapia antitromb&#243;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de evento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Klok et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;14&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heparina profil&#225;ctica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 pacientes con TEPUn paciente con TVPOtros&#58; un TVP de extremidad superior asociada a cat&#233;ter y 3 ictus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Llitjos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;69&#41; para trombosis venosa de EEII y 6 &#40;23&#41; para TEP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 pacientes heparina profil&#225;ctica18 pacientes heparina terap&#233;utica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 pacientes con TEP14 pacientes con TVP4 pacientes con TVS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cui et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No administrado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 pacientes con TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poissy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;20&#44;6&#41; para TEP y 5 &#40;4&#44;7&#41; para TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 pacientes heparina profil&#225;cticaUn paciente AVKUn paciente heparina terap&#233;utica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 pacientes con TEP&#59; 3 pacientes con TVP concomitante &#40;13&#44;6&#37;&#41;5 pacientes con TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lodigiani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">388&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI y UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; de pacientes de UCI heparina profil&#225;ctica75&#37; de pacientes de UH heparina profil&#225;ctica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 pacientes con TEP&#59; 1 paciente con TVP concomitante &#40;10&#37;&#41;4 pacientes con TVP proximalUn paciente con TVP distalOtros&#58; 1 TVP de extremidad superior asociada a cat&#233;ter&#44; 9 ictus y 4 SCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Helms et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;16&#44;7&#41; para TEP y 3 &#40;2&#41; para TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heparinaprofil&#225;ctica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 pacientes con TEP3 pacientes con TVPOtros&#58; 2 ictus&#44; una isquemia mesent&#233;rica y una isquemia arterial perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Middeldorp et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI y UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heparinaprofil&#225;ctica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 pacientes con TEP14 pacientes con TVP proximal11 pacientes con TVP distalUn paciente con TVP de extremidad superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2387501.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Series de casos de pacientes con COVID-19 y TEV</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Klok FA&#44; Kruip MJHA&#44; van der Meer NJM&#44; Arbous MS&#44; Gommers DAMPJ&#44; Kant KM&#44; et al&#46; Incidence of thrombotic complications in critically ill ICU patients with COVID-19&#46; Thrombosis Research&#46; DOI&#58; 10&#46;1016&#47;j&#46;thromres&#46;2020&#46;04&#46;013"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Llitjos"
                            1 => "M&#46; Leclerc"
                            2 => "C&#46; Chochois"
                            3 => "J&#46;M&#46; Monsallier"
                            4 => "M&#46; Ramakers"
                            5 => "M&#46; Auvray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jth.14869"
                      "Revista" => array:2 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Cui"
                            1 => "S&#46; Chen"
                            2 => "X&#46; Li"
                            3 => "S&#46; Liu"
                            4 => "F&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jth.14830"
                      "Revista" => array:2 [
                        "tituloSerie" => "J Thromb Haemost"
                        "fecha" => "2020"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary Embolism in COVID-19 Patients&#58; Awareness of an Increased Prevalence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Poissy"
                            1 => "J&#46; Goutay"
                            2 => "M&#46; Caplan"
                            3 => "E&#46; Parmentier"
                            4 => "T&#46; Duburcq"
                            5 => "F&#46; Lassalle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.120.047430"
                      "Revista" => array:3 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2020"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29752376"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan&#44; Italy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Lodigiani"
                            1 => "G&#46; Iapichino"
                            2 => "L&#46; Carenzo"
                            3 => "M&#46; Cecconi"
                            4 => "P&#46; Ferrazzi"
                            5 => "T&#46; Sebastian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.thromres.2020.04.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thromb Res"
                        "fecha" => "2020"
                        "volumen" => "191"
                        "paginaInicial" => "9"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32353746"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High risk of thrombosis in patients with severe SARS-CoV-2 infection&#58; A multicenter prospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Helms"
                            1 => "C&#46; Tacquard"
                            2 => "F&#46; Severac"
                            3 => "I&#46; Leonard-Lorant"
                            4 => "M&#46; Ohana"
                            5 => "X&#46; Delabranche"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-020-06062-x"
                      "Revista" => array:3 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2020"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21365313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of venous thromboembolism in hospitalized patients with COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
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Tromboembolismo pulmonar y COVID-19: un cambio de paradigma
Pulmonary embolism and COVID-19: A paradigm change
A. Franco-Moreno
Autor para correspondencia
anaisabel.franco@salud.madrid.org

Autor para correspondencia.
, N. Muñoz-Rivas, B. Mestre-Gómez, J. Torres-Macho
Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El 31 de diciembre de 2019 se detect&#243; en la ciudad de Wuhan &#40;China&#41; un brote de neumon&#237;a por un nuevo coronavirus&#44; designado como SARS-CoV-2&#46; Desde el punto de vista cl&#237;nico&#44; los pacientes infectados pueden presentar desde un cuadro leve de v&#237;as respiratorias altas hasta una neumon&#237;a grave asociada a un s&#237;ndrome de&#160;distr&#233;s&#160;respiratorio que podr&#237;a progresar hacia una insuficiencia respiratoria grave y el fallecimiento del paciente&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Aunque esta nueva enfermedad afecta fundamentalmente al tracto respiratorio&#44; varios estudios observacionales sugieren que la infecci&#243;n por SARS-CoV-2 &#40;COVID-19&#41; predispone a fen&#243;menos tromb&#243;ticos de localizaci&#243;n venosa&#44; siendo el tromboembolismo pulmonar &#40;TEP&#41; el m&#225;s frecuente<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#8211;7</span></a>&#46; Este aumento de manifestaciones tromb&#243;ticas pulmonares se ha descrito en autopsias de pacientes infectados en las epidemias por los coronavirus SARS-CoV y MERS-CoV en 2003 y 2012&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La fisiopatolog&#237;a que relaciona el TEP con la infecci&#243;n por SARS-CoV-2 no se conoce bien y parece estar relacionada con un estado de hipercoagulabilidad&#46; Estudios recientes han demostrado que niveles de d&#237;mero D superiores a 1&#46;000 ng&#47;ml en pacientes con COVID-19 constituyen un &#237;ndice pron&#243;stico relevante de mortalidad<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; La respuesta inflamatoria sist&#233;mica y el da&#241;o endotelial asociados a la infecci&#243;n v&#237;rica activar&#237;an la coagulaci&#243;n&#44; con aumento de la generaci&#243;n de trombina y disminuci&#243;n de los anticoagulantes naturales del organismo&#46; Hace a&#241;os se acu&#241;&#243; esta interrelaci&#243;n entre el sistema inmune y el sistema de coagulaci&#243;n como respuesta a una infecci&#243;n para evitar su propagaci&#243;n con el t&#233;rmino &#171;inmunotrombosis&#187;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El SARS-CoV-2 penetra en las c&#233;lulas epiteliales alveolares a trav&#233;s del receptor de superficie de la enzima convertidora de la angiotensina 2 &#40;ACE2&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; La replicaci&#243;n viral desencadena la activaci&#243;n del complemento&#44; con formaci&#243;n de C3a y C5a&#44; capaces de reclutar neutr&#243;filos&#44; macr&#243;fagos&#44; linfocitos y monocitos&#44; responsables a su vez de la liberaci&#243;n masiva de citoquinas proinflamatorias &#40;IL-1&#44; IL-6&#44; IL-8 e interfer&#243;n-&#947;&#41; que favorecen la expresi&#243;n del factor tisular &#40;FT&#41; de trombomodulina y de mol&#233;culas de adhesi&#243;n endotelial&#44; y activan la fibrin&#243;lisis&#44; entre otros<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; el SARS-CoV-2 infecta las c&#233;lulas endoteliales que expresan ACE2&#46; Este da&#241;o endotelial activa el FT&#44; que genera trombina a partir de la protrombina por acci&#243;n del factor X activado&#59; las plaquetas circulantes activadas se agregan y proporcionan la superficie fosfolip&#237;dica adecuada para la adhesi&#243;n de los diferentes compuestos de la cascada de la coagulaci&#243;n con la generaci&#243;n de gran cantidad de trombina&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recientemente&#44; Ciceri et al&#46; han propuesto el acr&#243;nimo MicroCLOTS <span class="elsevierStyleItalic">&#40;microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome&#41;</span> para designar esta microangiopat&#237;a tromb&#243;tica pulmonar o trombosis <span class="elsevierStyleItalic">in situ</span><a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#46; Concordante con esta hip&#243;tesis fisiopatol&#243;gica se han hallado en las autopsias de pacientes fallecidos por COVID-19 trombos&#160;de fibrina en vasos arteriales pulmonares de peque&#241;o tama&#241;o<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Por ello parece interesante conocer la incidencia de trombosis venosa profunda &#40;TVP&#41; en pacientes con COVID-19 y TEP&#46; Seg&#250;n las series&#44; en pacientes con TEP la presencia de TVP concomitante var&#237;a entre un 35-45&#37;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46; Aunque el 20&#37; de pacientes con TEP pueden presentar TVP no diagnosticada&#44; los estudios de Poissy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> y Lodigiani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> observaron una incidencia de TVP del 13&#44;6 y 10&#37;&#44; respectivamente&#44; en pacientes con COVID-19 y TEP&#46; Las series de casos de pacientes con COVID-19 y TEV publicadas se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la insuficiencia respiratoria grave que desarrollan los pacientes con COVID-19 podr&#237;a explicarse en parte por una microangiopat&#237;a tromb&#243;tica pulmonar consecuencia de una respuesta inmune exagerada del hu&#233;sped&#46; La coagulopat&#237;a presente en estos pacientes ha promovido que se planteen diferentes estrategias antitromb&#243;ticas&#44; especialmente en pacientes graves ingresados en unidades de cuidados intensivos &#40;UCI&#41;&#46; Aunque no conocemos la mejor estrategia antitromb&#243;tica&#44; las heparinas de bajo peso molecular a dosis profil&#225;cticas o dosis intermedias deber&#237;an indicarse en estos pacientes &#40;salvo contraindicaci&#243;n&#41;&#44; reserv&#225;ndose la anticoagulaci&#243;n terap&#233;utica para los casos en los que se objetive o se sospeche una trombosis<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se necesitan ensayos&#160;controlados aleatorios para determinar la idoneidad de la tromboprofilaxis primaria m&#225;s all&#225; del alta hospitalaria y el tiempo &#243;ptimo de tratamiento anticoagulante en pacientes con TEP&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AVK&#58; antagonista de la vitamina K&#59; EEII&#58; extremidades inferiores&#59; SCA&#58; s&#237;ndrome coronario agudo&#59; TEP&#58; tromboembolismo pulmonar&#59; TEV&#58; tromboembolismo venoso&#59; TVP&#58; trombosis venosa profunda&#59; TVS&#58; trombosis venosa superficial&#59; UCI&#58; unidad de cuidados intensivos&#59; UH&#58; unidad de hospitalizaci&#243;n&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#193;mbito del estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidencia de TEV &#40;n&#59; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R&#233;gimen de terapia antitromb&#243;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de evento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Klok et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;14&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heparina profil&#225;ctica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 pacientes con TEPUn paciente con TVPOtros&#58; un TVP de extremidad superior asociada a cat&#233;ter y 3 ictus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Llitjos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18 &#40;69&#41; para trombosis venosa de EEII y 6 &#40;23&#41; para TEP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 pacientes heparina profil&#225;ctica18 pacientes heparina terap&#233;utica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 pacientes con TEP14 pacientes con TVP4 pacientes con TVS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cui et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No administrado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 pacientes con TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poissy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;20&#44;6&#41; para TEP y 5 &#40;4&#44;7&#41; para TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 pacientes heparina profil&#225;cticaUn paciente AVKUn paciente heparina terap&#233;utica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 pacientes con TEP&#59; 3 pacientes con TVP concomitante &#40;13&#44;6&#37;&#41;5 pacientes con TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lodigiani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">388&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI y UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; de pacientes de UCI heparina profil&#225;ctica75&#37; de pacientes de UH heparina profil&#225;ctica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 pacientes con TEP&#59; 1 paciente con TVP concomitante &#40;10&#37;&#41;4 pacientes con TVP proximalUn paciente con TVP distalOtros&#58; 1 TVP de extremidad superior asociada a cat&#233;ter&#44; 9 ictus y 4 SCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Helms et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 &#40;16&#44;7&#41; para TEP y 3 &#40;2&#41; para TVP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Heparinaprofil&#225;ctica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 pacientes con TEP3 pacientes con TVPOtros&#58; 2 ictus&#44; una isquemia mesent&#233;rica y una isquemia arterial perif&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Middeldorp et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">UCI y UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heparinaprofil&#225;ctica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 pacientes con TEP14 pacientes con TVP proximal11 pacientes con TVP distalUn paciente con TVP de extremidad superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Información del artículo
ISSN: 00142565
Idioma original: Español
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2022 Abril 247 60 307
2022 Marzo 273 58 331
2022 Febrero 266 37 303
2022 Enero 280 30 310
2021 Diciembre 183 36 219
2021 Noviembre 284 50 334
2021 Octubre 350 63 413
2021 Septiembre 318 84 402
2021 Agosto 396 57 453
2021 Julio 310 64 374
2021 Junio 267 60 327
2021 Mayo 311 55 366
2021 Abril 713 196 909
2021 Marzo 373 60 433
2021 Febrero 425 67 492
2021 Enero 445 68 513
2020 Diciembre 379 82 461
2020 Noviembre 440 106 546
2020 Octubre 552 110 662
2020 Septiembre 528 125 653
2020 Agosto 665 141 806
2020 Julio 226 71 297
2020 Junio 753 157 910
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