The relationship between coagulation disorders and the risk of bleeding in cirrhotic patients

array:24 ["pii" => "S1665268119300717" "issn" => "16652681" "doi" => "10.1016/j.aohep.2018.12.007" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "63" "copyright" => "Fundación Clínica Médica Sur, A.C." "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2019;18:627-32" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 491 "formatos" => array:3 [ "EPUB" => 28 "HTML" => 319 "PDF" => 144 ] ] "itemSiguiente" => array:19 [ "pii" => "S1665268119300729" "issn" => "16652681" "doi" => "10.1016/j.aohep.2018.12.008" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "64" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2019;18:633-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 393 "formatos" => array:3 [ "EPUB" => 34 "HTML" => 178 "PDF" => 181 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Folic acid ameliorates homocysteine-induced angiogenesis and portosystemic collaterals in cirrhotic rats" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "633" "paginaFinal" => "639" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1392 "Ancho" => 2083 "Tamanyo" => 273077 ] ] "descripcion" => array:1 [ "en" => "Splanchnic hemodynamic parameters of cirrhotic rats with vehicle (V), homocysteine (H), homocysteine plus folic acid (H+F) or folic acid (F) administration. The number of each group was 8, 7, 5, 8, respectively. As compared with the vehicle group, homocysteine significantly increased SMA flow (P=0.046), which was tended to be reduced by folic acid. SMA: superior mesenteric artery; PV: portal vein." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hsin-Ling Ho, Ming-Hung Tsai, Yu-Hsin Hsieh, Teh-Ia Huo, Ching-Chih Chang, Fa-Yauh Lee, Hui-Chun Huang, Ming-Chih Hou, Shou-Dong Lee" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Hsin-Ling" "apellidos" => "Ho" ] 1 => array:2 [ "nombre" => "Ming-Hung" "apellidos" => "Tsai" ] 2 => array:2 [ "nombre" => "Yu-Hsin" "apellidos" => "Hsieh" ] 3 => array:2 [ "nombre" => "Teh-Ia" "apellidos" => "Huo" ] 4 => array:2 [ "nombre" => "Ching-Chih" "apellidos" => "Chang" ] 5 => array:2 [ "nombre" => "Fa-Yauh" "apellidos" => "Lee" ] 6 => array:2 [ "nombre" => "Hui-Chun" "apellidos" => "Huang" ] 7 => array:2 [ "nombre" => "Ming-Chih" "apellidos" => "Hou" ] 8 => array:2 [ "nombre" => "Shou-Dong" "apellidos" => "Lee" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300729?idApp=UINPBA00004N" "url" => "/16652681/0000001800000004/v3_201908230828/S1665268119300729/v3_201908230828/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119300687" "issn" => "16652681" "doi" => "10.1016/j.aohep.2018.12.005" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "60" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2019;18:620-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 452 "formatos" => array:3 [ "EPUB" => 20 "HTML" => 248 "PDF" => 184 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Advantages of adipose tissue stem cells over CD34+ mobilization to decrease hepatic fibrosis in Wistar rats" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "620" "paginaFinal" => "626" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1965 "Ancho" => 2083 "Tamanyo" => 189004 ] ] "descripcion" => array:1 [ "en" => "Quantification of collagen in liver tissue and immunohistochemical analysis of the groups evaluated after treatment at 16 weeks. (A) Quantification of collagen percentage stained with sirius red. (B) Immunohistochemistry proliferating cell nuclear antigen (PCNA) in liver tissue: evaluation of staining intensities. Mean±SD (n=3). Significant differences in both analysis. *p<0.05, **p<0.001." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcela M. De Luna-Saldivar, Iván A. Marino-Martinez, Moisés A. Franco-Molina, Lydia G. Rivera-Morales, Gabriela Alarcón-Galván, Paula Cordero-Pérez, Augusto Rojas-Martínez, Cristina Rodríguez-Padilla, Linda E. Muñoz-Espinosa" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Marcela M." "apellidos" => "De Luna-Saldivar" ] 1 => array:2 [ "nombre" => "Iván A." "apellidos" => "Marino-Martinez" ] 2 => array:2 [ "nombre" => "Moisés A." "apellidos" => "Franco-Molina" ] 3 => array:2 [ "nombre" => "Lydia G." "apellidos" => "Rivera-Morales" ] 4 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Alarcón-Galván" ] 5 => array:2 [ "nombre" => "Paula" "apellidos" => "Cordero-Pérez" ] 6 => array:2 [ "nombre" => "Augusto" "apellidos" => "Rojas-Martínez" ] 7 => array:2 [ "nombre" => "Cristina" "apellidos" => "Rodríguez-Padilla" ] 8 => array:2 [ "nombre" => "Linda E." "apellidos" => "Muñoz-Espinosa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300687?idApp=UINPBA00004N" "url" => "/16652681/0000001800000004/v3_201908230828/S1665268119300687/v3_201908230828/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "The relationship between coagulation disorders and the risk of bleeding in cirrhotic patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "627" "paginaFinal" => "632" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Asma Labidi, Héla Baccouche, Monia Fekih, Sonia Mahjoub, Nadia BenMustapha, Meriem Serghini, Neila BenRomdhane, Jalel Boubaker" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Asma" "apellidos" => "Labidi" "email" => array:2 [ 0 => "asma.labidy@gmail.com" 1 => "asma.labidi@fmt.utm.tn" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Héla" "apellidos" => "Baccouche" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Monia" "apellidos" => "Fekih" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Sonia" "apellidos" => "Mahjoub" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Nadia" "apellidos" => "BenMustapha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Meriem" "apellidos" => "Serghini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Neila" "apellidos" => "BenRomdhane" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Jalel" "apellidos" => "Boubaker" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Gastroenterology and Hepatology, Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Hematology, Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 2342 "Tamanyo" => 61728 ] ] "descripcion" => array:1 [ "en" => "Comparison of ETP ratio between (H+) patients and controls (A), and between (H+) and (H−) patients (B). H+: cirrhotic patients who experienced bleeding; H−: cirrhotic patients who did not experienced bleeding; ETP: endogenous thrombin potential." ] ] ] "textoCompleto" => "1IntroductionBleeding often complicates the clinical course of cirrhosis. The most frequent and potentially life-threatening site of bleeding is the gastrointestinal tract. It could result from a variety of lesions including gastro-esophageal varices and portal hypertensive gastropathy or other lesions seen in the general population like esophagitis, Mallory-Weiss tears and peptic ulcer disease. Mortality rates related to gastrointestinal bleeding are high; up to 30% of initial variceal bleeding episodes are fatal <a class="elsevierStyleCrossRef" href="#bib0145">[1]</a>. Patients with cirrhosis may also experience cutaneous or mucosa-associated bleeding including bruising, purpura, epistaxis, gingival bleeding, menorrhagia, and bleeding associated with invasive procedures such as liver biopsy. For long, this increased hemorrhagic risk has been thought to be related to acquired hemostatic disorders in cirrhotic patients. In fact, liver synthesizes almost all coagulation factors with the exception of factor VIII. It has been thought that the reduced synthesis of clotting factors was responsible for abnormal conventional laboratory tests exploring global clotting activation, such as prothrombin time (PT) and activated partial thromboplastin (aPTT). However it has been noted that despite prolonged PT and aPTT, many cirrhotic patients do not experience bleeding even after liver biopsy or other potentially hemorrhagic procedures <a class="elsevierStyleCrossRef" href="#bib0150">[2]</a>. Furthermore, some cirrhotic patients do experience thromboembolic events despite abnormal conventional laboratory tests. Thus far, only few studies have investigated the impact of coagulation disorders on bleeding risk in cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0155">[3,4]</a>.This study aims to assess the relationship between hemostatic disorders and the risk of bleeding in cirrhotic patients through investigating hemostatic balance in cirrhotic patients with and without bleeding in comparison with controls.2Materials and methodsThe study was performed in accordance with the Declaration of Helsinki of the World Medical Association and was approved by the local ethics committee. All patients gave their informed consent prior to inclusion in the study.2.1Patient population and study designFifty-one cirrhotic patients constituted the group of cases and 50 healthy controls matched for age and sex were included in a cross-sectional study. Data regarding bleeding episodes, characteristics of cirrhosis and medication were abstracted from medical records. The severity of cirrhosis was estimated according to Child Turcotte Pugh score. Patients who had bleeding episodes within 2 months before or after inclusion were identified. For each of these patients, site and severity of bleeding were determined. Patients who experienced bleeding with deglobulisation (fall of the hemoglobin of 2g/dl or more) requiring or not a transfusion were considered as having severe hemorrhage. Exclusion criteria were hepatocellular carcinoma or any other malignancy, bacterial infection, chronic inflammatory disease, nephrotic syndrome, renal failure, known inherited coagulation abnormalities and use of anticoagulant or anti-platelet drugs. Patients were divided into two groups: (H+) group included patients who experienced bleeding episodes and (H−) group included patients who did not.2.2Blood collectionBlood sample was drawn through venipuncture into plastic tubes containing 3.2% sodium citrate as an anticoagulant in the proportion of one to nine parts of anticoagulant/blood. Poor platelet plasma (PPP) was obtained after a double blood centrifugation at 2500×g for 15min. PPP was aliquoted and frozen at −80°C until coagulation tests were performed.2.3Laboratory tests2.3.1Conventional laboratory testsThe prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured, respectively, with the human thromboplastin (neoplastin, STAGO) and the automated APTT reagent (APTT, STAGO). The fibrinogen was measured with (STA fibrinogen, STAGO).2.3.2Pro and anticoagulant factorsThe pro and anticoagulant factor activities were determined as functional activities using STAGO reagents: Factor VIII and XII activities were measured with standard aPTT based clotting assays (respectively with DEFICIENT VIII and IMMUNODEF XII). Factor VII, factor V and factor II activities were measured with PT based clotting assays (respectively with DEFICIENT VII, DEFICIENT V, IMMUNODEF II). Protein C (PC) and Protein S (PS) activities were measured using clotting assays (STACLOT PC and STACLOT PS). Antithrombin (AT) activity was determined using chromogenic assay (STACHROM AT). All tests were performed on STA COMPACT MAX (STAGO; Asnières France). Platelet count was performed on the hematology analyzer (SYSMEX XT 2000i; Cobe, Japan).2.3.3Thrombin generationThrombin generation (TG) was measured by means of calibrated automated thrombin method (thrombiniscope-Thermosystem). The coagulation was triggered in the PPP after addition of tissue factor 1pmol/L and phospholipids (PPP reagent low-STAGO) into two steps: in the absence then in the presence of protein C activator (PROTAC; STACLOT PC STAGO). Registration of the thrombin generated over time was carried out with a fluorogenic substrate (FLUCAT, STAGO). The TG was expressed as endogenous thrombin potential (ETP) in nmol×min.2.3.4Hemostatic balanceHemostatic balance was assessed by means of procoagulant to anticoagulant factor ratios and ETP ratio with/without PC activator.2.4Statistical analysisStatistical Package for Social Science (SPSS) software version 21.0 (IBM Corp., Armonk. New York, USA) was used for analysis of data. Data were summarized as mean and percentage. Study groups were compared using the χ2 test for qualitative variables. Student's t and ANOVA tests were used for analysis of parametric data. Mann–Whitney U and Kruskal–Wallis H tests were used for analysis of non-parametric data. p-Value less than or equal to 0.05 was considered significant.3ResultsMean age of patients at inclusion was 57.8 years (16–91 years). Mean age at diagnosis of cirrhosis was 55 years (6–88 years). There were 24 males and 27 females. Major etiology of cirrhosis was viral hepatitis (64.7%). Patients were categorized according to Child–Pugh score as class A in 14 patients (27.5%), class B in 22 patients (43.2%), and class C in 15 patients (29.3%). (H+) group included 9 patients (17.6%). Bleeding episodes were variceal hemorrhage (n=6), gastrointestinal bleeding secondary to gastric (n=1) and duodenal (n=1) ulcers and gingivorrhagia (n=1). Hemorrhage was judged mild to moderate in 6 patients and severe in 3 others. Both patient groups were comparable regarding age, sex and Child–Pugh score.Obviously, as regards controls, no bleeding episodes occurred within 2 months before or after inclusion.3.1Conventional laboratory testsThere was no significant difference in mean levels of PT, aPTT and fibrinogen between (H+) and (H−) groups. Platelet count was significantly lower in (H+) patients than in (H−) patients (p=0.01) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>3.2Procoagulant and anticoagulant factorsMean levels of pro-and anticoagulant factors were significantly lower in cirrhotic patients who experienced bleeding episodes (H+) than in controls. However, factor VIII was significantly higher in cirrhotic patients than in controls (166% vs. 94.5%; p=0.045). There was no significant difference between both (H+) and (H−) groups as regards levels of pro- and anticoagulant factors (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>3.3Thrombin generationThere was no significant difference between (H+) patients and controls as regards ETP mean level without PC activator (716.1 vs. 811nmol×min respectively; p=0.5). In the presence of PC activator, ETP was surprisingly higher in (H+) patients than in controls (725 vs. 387nmol×min; p=0.05).However, there was no significant difference between patient groups as regards ETP with and without PC activator.3.4Hemostatic balance3.4.1The ratios of pro- to anticoagulant factorsCompared with controls, VIII/anticoagulant factors (VIII/PC, VIII/PS, VIII/AT), VII/PC and XII/PC were significantly higher in (H+) patients. All other ratios were roughly at the same levels.No significant difference as regards all ratios between patients who experienced bleeding (H+) and those who did not (H−) was detected (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>3.4.2ETP ratioETP ratio with/without PC activator was significantly higher in (H+) patients than in controls (0.97 vs. 0.51; p=0.017) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>However, there was no significant difference between patient groups as regards ETP ratio (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).4DiscussionThe current study showed that the hemostatic balance assessed by ratios of pro- to anticoagulant factors and ETP ratio with/without PC activator was in favor of a hypercoagulability state even in cirrhotic patients who experienced bleeding events. When comparing both patient groups, cirrhotic patients who had bleeding generated roughly as much thrombin as those who had not. To our knowledge, there were no published studies investigating the impact of thrombin generation assay in assessing the bleeding risk in cirrhosis.However, the main limitation of this study is the small number of cirrhotic patients who experienced bleeding.The bleeding tendency in cirrhotic patients namely in those with advanced liver disease was supported by many clinical observations <a class="elsevierStyleCrossRef" href="#bib0165">[5]</a>. The most relevant hemorrhagic events in such patients result from esophageal varices rupture and portal hypertensive gastropathy <a class="elsevierStyleCrossRef" href="#bib0170">[6]</a>. Bleeding may occur also from the same lesions seen in the general population such as peptic ulcer, epistaxis, gingivorrhagia, bruising or from invasive procedures. In our study, variceal bleeding was the most common site of hemorrhage as it occurred in two-thirds of patients.Historically, hemostatic abnormalities due to liver failure such as prolonged PT and aPTT were assumed to reflect bleeding disorders that frequently occur in cirrhotic patients. Thus, PT has frequently been corrected by means of fresh frozen plasma prior to liver biopsy or other potentially hemorrhagic procedures <a class="elsevierStyleCrossRef" href="#bib0175">[7]</a>.In the present study, there was not any significant difference between patients who experienced bleeding and those who did not as regards PT and aPTT mean levels. Our results are in accordance with those of many papers suggesting these conventional tests are not as good at predicting bleeding in acquired as compared with congenital coagulopathies <a class="elsevierStyleCrossRef" href="#bib0180">[8]</a>. In fact, Segal et al. found no evidence to conclude that prolonged PT could predict bleeding during invasive diagnostic procedures <a class="elsevierStyleCrossRef" href="#bib0185">[9]</a>. Furthermore, Tripodi noted that, paradoxically, cirrhotic patients with near-normal PT could bleed whereas patients with relatively abnormal PT commonly did not <a class="elsevierStyleCrossRef" href="#bib0190">[10]</a>. The lack of its bleeding predictive power can best be explained by the fact that only the procoagulant but not the anticoagulant activity (PC, PS, AT) is being reflected by PT <a class="elsevierStyleCrossRef" href="#bib0195">[11]</a>. Since both procoagulant and anticoagulant factors are decreased in cirrhosis, PT and aPTT could not represent the balance between pro-and anticoagulant factors <a class="elsevierStyleCrossRef" href="#bib0165">[5]</a>.With regard to platelet count assessed in the present study, patients who experienced bleeding had significantly lower levels than patients who did not (p=0.01). Our results were in agreement with those of El Bokl et al. where platelet count was found to be significantly lower in cirrhotic patients who experienced hematemesis and melena than those who did not have bleeding episodes (p<0.0001) <a class="elsevierStyleCrossRef" href="#bib0155">[3]</a>. These findings could be supported by the multiple quantitative and qualitative alterations that could affect platelets in patients with chronic liver disease. Increased platelet sequestration in the spleen caused by portal hypertension and decreased thrombopoietin production by the diseased liver are main mechanisms of thrombocytopenia in cirrhotic patients <a class="elsevierStyleCrossRef" href="#bib0200">[12]</a>. Besides thrombocytopenia, defective platelet function has also been found since adhesion, aggregation and then capacity to support thrombin generation are impaired in cirrhotic patients. These findings were supported by several clinical observations showing that a platelet count <60,000/mm3 was associated with a significantly increased risk of bleeding related to invasive procedures <a class="elsevierStyleCrossRef" href="#bib0205">[13]</a>. Thus, platelet count seems to be more reliable than other hemostatic conventional tests (TP or aPTT) in assessing bleeding risk. Although there is no prospective studies determining the threshold platelet count for prophylactic transfusion in cirrhotic patients, AASLD guidelines for liver biopsy recommend consideration of platelet transfusion prior to liver biopsy for a platelet count <50,000–60,000/mm3 (Class I level C) <a class="elsevierStyleCrossRef" href="#bib0175">[7]</a>.In the current study, there was not any difference between (H+) and (H−) patients with regard to plasma fibrinogen level. However, Siddiqui et al. found significant correlation for decreased fibrinogen level with gastrointestinal bleeding in cirrhotic patients (RR=1.47; 95% CI, 0.64–3.35) <a class="elsevierStyleCrossRef" href="#bib0160">[4]</a>.In fact, hypofibrinogenemia which is frequently seen in patients with advanced cirrhosis is thought to increase bleeding risk since fibrinogen serves both as a precursor of fibrin and a mediator of platelet aggregation <a class="elsevierStyleCrossRef" href="#bib0210">[14]</a>. Bleeding risk is considered particularly high when fibrinogen levels are below 1g/L <a class="elsevierStyleCrossRef" href="#bib0215">[15]</a>. In the present study, our results as regards fibrinogen levels could be explained by the fact that the majority of patients had stable liver disease.In the present study, procoagulant (II, V, VII and XII) and anti-coagulant factors (PC, PS and AT) were significantly lower in cirrhotic patients who had bleeding than in controls. However, FVIII was markedly increased in the former group. Several previous studies were in agreement with our results regardless of bleeding or thrombotic status of cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0220">[16–18]</a>.When comparing (H+) and (H−) patients, no difference in levels of pro-and anticoagulant factors was detected. In line with our results, El Bokl et al. showed no significant difference between both patient groups as regards FVIII level. However, paradoxically, PC was significantly lower in cirrhotic patients who experienced bleeding in comparison with those who did not (36.4% vs. 65%; p=0.018) <a class="elsevierStyleCrossRef" href="#bib0155">[3]</a>. These findings suggest that bleeding events in cirrhotic patients are not related to plasma levels of coagulation factors. Indeed, randomized controlled trials provide evidence against effectiveness of recombinant activated factor VII infusion in controlling bleeding from varices or during hepatectomy <a class="elsevierStyleCrossRefs" href="#bib0235">[19,20]</a>.In the present study, regarding hemostatic balance, VIII/anticoagulant factors (VIII/PC; VIII/PS and VIII/AT), VII/PC and XII/PC were significantly higher in (H+) patients than in controls. All other ratios were roughly at the same levels between (H+) patients and controls. Similarly, previous studies showed that ratios pro- to anticoagulant factors (II/PC, V/PC, VIII/PC and VIII/AT) were significantly higher in cirrhotic patients than in controls <a class="elsevierStyleCrossRefs" href="#bib0220">[16,17,21]</a>.In the current study, all ratios of pro- to anticoagulant factors were at the same levels between both patient groups. However, El Bokl et al. showed paradoxically a significant higher level of FVIII/PC in cirrhotic patients who had bleeding events than in patients who had not <a class="elsevierStyleCrossRef" href="#bib0155">[3]</a>.With regard to thrombin generation assessed in the current study, there was no difference across controls and patient groups.After activation of PC, ETP ratio was significantly higher in (H+) patients than in controls (p=0.017). These findings were in agreement with those of Tripodi et al. suggesting a state of resistance to the anticoagulant effect of activated PC in cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0225">[17,18]</a>. This “hypercoagulability status” could even have a protective effect against bleeding in cirrhotic patients. In the same context, ETP ratio did not reach statistical significance between both patient groups. This finding provides an additional argument against the traditional tenet holding that coagulation disorders detected in cirrhotic patients are predictors of bleeding.It appears that gastrointestinal bleeding may be explained by hemodynamic alterations related to portal hypertension. Advanced liver disease, large varices, variceal wall tension and the presence of red wale marking have been reported as risk factors for variceal bleeding in cirrhotic patients <a class="elsevierStyleCrossRef" href="#bib0250">[22]</a>. Endothelial dysfunctions, bacterial infections and renal failure may also contribute to gastrointestinal bleeding <a class="elsevierStyleCrossRef" href="#bib0255">[23]</a>. Other bleeding events such as epistaxis, gingivorrhagia and bruising may be explained by thrombocytopenia, which is in turn mainly due to portal hypertension <a class="elsevierStyleCrossRef" href="#bib0255">[23]</a>.Before concluding, it is worth noting that in patients with chronic liver disease, vitamin k deficiency is one of the main factors implicated in coagulation disorders described above. Indeed, vitamin K deficiency may result in, not only decreased synthesis of coagulation factors but also in producing under-carboxylated precursors of these proteins that are functionally inactive. These proteins are known as proteins induced by vitamin K absence (PIVKA) such as undercaboxylated prothrombine (PIVK-II) which has been shown to be secreted by hepatocellular carcinoma cells in cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0260">[24,25]</a>. Although it has been reported in some previous studies that the administration of vitamin K in such patients did not improve coagulation disorders, data regarding the sensitivity of under-carboxylated prothrombin are still conflicting <a class="elsevierStyleCrossRefs" href="#bib0270">[26,27]</a>. Hence, we could speculate that it would probably be wise not to administer vitamin K in cirrhotic patients in order to prevent a significant decrease of the level of undercarboxylated prothrombin which may play a role in the early diagnosis of hepatocellular carcinoma in such patients <a class="elsevierStyleCrossRef" href="#bib0280">[28]</a>.In conclusion, although our findings should be interpreted cautiously due to the small number of (H+) patients, they may support the concept that abnormal conventional laboratory tests such as prolonged PT and aPTT do not correlate with bleeding risk in cirrhotic patients. However, platelet count seems to be a better predictor of bleeding than PT and aPTT. The hemostatic balance is shifted toward a hypercoagulability state even in cirrhotic patients who experienced bleeding. We surmise that gastrointestinal bleeding in such patients is mainly hemodynamic due to portal hypertension. Further studies should take into account the fibrinolytic system. In fact, hyperfibrinolysis has been reported in some cases as a cause of bleeding in cirrhotic patients, although this concept remains controversial <a class="elsevierStyleCrossRef" href="#bib0190">[10]</a>.AbbreviationsETPendogenous thrombin potentialPCprotein CPTprothrombin timeaPTTactivated partial thromboplastinPPPpoor platelet plasmaPSprotein SATantithrombinTGthrombin generationCopyright assignmentIn consideration of the Fundación Clínica Médica Sur (FCMS) taking action to review and edit my submission, the undersigned authors, jointly and severally, hereby transfer, convey, and assign all right, title, and interest therein, including any and all copyrights in all forms and media now or hereafter known, to the FCMS. The authors retain the nonexclusive right to use all or part of the Article in future works of their own in a noncompeting way, provided proper copyright credit is given to the Foundation. Should the FCMS not publish the aforesaid submission, the FCMS agrees to release its rights therein (Note: material prepared by employees of the federal government in their official duties may not be copyrightable). No guarantee is made that the Article will be published.Authorship responsibilityI, the undersigned author, certify that I have participated sufficiently in the intellectual content, the analysis of data, if applicable, and the writing of the Article, to take public responsibility for it. I have reviewed the final version of the Article, believe it represents valid work, and approve it for publication. As an author of this Article, I certify that none of the material in the manuscript has been published previously, is included in another manuscript, or is currently under consideration for publication elsewhere. I also certify that the Article has not been accepted for publication elsewhere, nor have I assigned any right or interest in the Article to any third party.Financial disclosureI, the undersigned author, certify that I have no commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements) that might pose a conflict of interest in connection with the submitted article. This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Institutional Review Board/Animal Care Committee ApprovalI, the undersigned author, certify that my institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.Author contributionsAsma labidi, Hela Baccouche, Monia Fekih and Neila BenRomdhane designed the study.Hela Baccouche carried out biological tests.Asma Labidi and Hela Baccouche analyzed the data.Asma labidi wrote the manuscript with the support of Hela Baccouche.All authors discussed the results and contributed to the final manuscript.Conflict of interestNone.Informed consentAll patients gave their informed consent for publication of the case details." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1233320" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1145652" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient population and study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Blood collection" ] 2 => array:3 [ "identificador" => "sec0025" "titulo" => "Laboratory tests" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Conventional laboratory tests" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Pro and anticoagulant factors" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Thrombin generation" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Hemostatic balance" ] ] ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Statistical analysis" ] ] ] 4 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Conventional laboratory tests" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Procoagulant and anticoagulant factors" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Thrombin generation" ] 3 => array:3 [ "identificador" => "sec0075" "titulo" => "Hemostatic balance" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "The ratios of pro- to anticoagulant factors" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "ETP ratio" ] ] ] ] ] 5 => array:2 [ "identificador" => "sec0090" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0095" "titulo" => "Copyright assignment" ] 7 => array:2 [ "identificador" => "sec0100" "titulo" => "Authorship responsibility" ] 8 => array:2 [ "identificador" => "sec0105" "titulo" => "Financial disclosure" ] 9 => array:2 [ "identificador" => "sec0110" "titulo" => "Institutional Review Board/Animal Care Committee Approval" ] 10 => array:2 [ "identificador" => "sec0115" "titulo" => "Author contributions" ] 11 => array:2 [ "identificador" => "sec0120" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "sec0125" "titulo" => "Informed consent" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-07" "fechaAceptado" => "2018-10-04" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1145652" "palabras" => array:5 [ 0 => "Gastrointestinal hemorrhage" 1 => "Hypercoagulability" 2 => "Liver" 3 => "Prothrombin time" 4 => "Thrombosis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and ObjectivesFor long, bleeding in cirrhotic patients has been associated with acquired coagulation disorders. The aim of our study was to investigate the impact of acquired coagulation disorders on bleeding risk in cirrhotic patients. Materials and methodsBlood samples were collected from 51 cirrhotic patients with (H+) or without (H−) bleeding events and 50 controls matched by age and sex. Thrombin generation was assessed as endogenous thrombin potential (ETP). Hemostatic balance was assessed by means of ratios of pro- to anticoagulant factors and by ETP ratio with/without protein C (PC) activator (ETP ratio). ResultsBleeding events occurred in 9 patients (17.6%). Compared with controls, VIII/anticoagulant factors, VII/PC and XII/PC were significantly higher in (H+) patients. No significant difference as regards all ratios across patient groups was detected. ETP ratio was significantly higher in (H+) patients than in controls (p=0.017). However, there was no significant difference between patient groups as regards ETP ratio. ConclusionHemostatic balance is shifted toward a hypercoagulability state even in cirrhotic patients who experienced bleeding. These findings provide evidence against traditional concept of hemostasis-related bleeding tendency in cirrhotic patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 2342 "Tamanyo" => 61728 ] ] "descripcion" => array:1 [ "en" => "Comparison of ETP ratio between (H+) patients and controls (A), and between (H+) and (H−) patients (B). H+: cirrhotic patients who experienced bleeding; H−: cirrhotic patients who did not experienced bleeding; ETP: endogenous thrombin potential." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "H+: cirrhotic patients who experienced bleeding; H−: cirrhotic patients who did not experienced bleeding; PT: prothrombin time; aPTT: activated partial thromboplastin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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">Parameters \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">H+ \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">H− \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">p-Value \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">Platelet count (/mm3) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62,888±33,650 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110,317±70,483 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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">PT (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.7±10.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62±21.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.1 \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">aPTT (ratio) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.40±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.26±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 \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">Fibrinogen (g/L) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.12±0.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6±0.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2106816.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "p<0.05." ] ] ] "descripcion" => array:1 [ "en" => "Comparison between patients groups as regards conventional laboratory tests." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "H+: cirrhotic patients who experienced bleeding; H−: cirrhotic patients who did not experienced bleeding." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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">Parameters \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">H+ \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">Controls \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">p value<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \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">H− \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">p-Value<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \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">Factor II (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.38±17.46 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.82±15.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.38±20.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.519 \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">Factor V (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.5±24.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.98±21.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.35±29.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.157 \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">Factor VII (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.25±23.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.98±23.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.09±43.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.188 \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">Factor XII (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.38±37.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.49±25.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.53±28.26 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.357 \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">Factor VIII (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">166±123.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.5±38.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.045 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">133.57±96.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.433 \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">Protein C (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.86±29.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116.54±28 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.08±24.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.146 \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">Protein S (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.71±19.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.07±19.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.39±21.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.187 \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">Antithrombin (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48±29.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.81±15.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.75±26.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.714 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2106818.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "(H+) group vs. controls." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "(H+) vs. (H−) group." ] ] ] "descripcion" => array:1 [ "en" => "Comparison between patients groups and controls as regards procoagulant and anticoagulant factors." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "PS: protein S; PC: protein C; AT: antithrombin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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">Parameters \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">H+ \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">Controls \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">p value<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \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">H− \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">p-Value<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \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">II/PS \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.37±1.0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.16±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.926 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.05±1.1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.493 \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">II/PC \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.41±0.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.75±0.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.15±0.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.233 \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">II/AT \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86±0.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92±0.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.531 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.651 \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">V/PS \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.31±1.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.27±0.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.694 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.24±1.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.885 \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">V/PC \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.38±1.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84±0.25 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.414 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.42±1.0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.756 \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">V/AT \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77±0.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.073 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.07±0.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.128 \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">VII/PS \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.51±1.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.29±0.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.437 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.45±1.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.984 \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">VII/PC \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.27±0.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82±0.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.030<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.34±0.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.664 \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">VII/AT \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.88±0.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.160 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.15±0.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.261 \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">XII/PS \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.06±2.0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.17±0.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.910 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.28±0.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.810 \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">XII/PC \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.69±0.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.78±1.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.470 \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">XII/AT \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.12±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.249 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.38±0.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.307 \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">VIII/PS \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.45±1.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.12±0.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.97±2.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.506 \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">VIII/PC \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.31±3.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7±0.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.88±4.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.598 \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">VIII/AT \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.88±1.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85±0.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.26±2.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.922 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2106817.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "(H+) group vs. controls." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "(H+) vs. (H−) group." ] 2 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "c" "nota" => "p<0.05." ] ] ] "descripcion" => array:1 [ "en" => "Comparison between patients groups and controls as regards ratios of pro to anticoagulant factors." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastroesophageal variceal hemorrhage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.I. Sharara" 1 => "D.C. Rockey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra003007" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "345" "paginaInicial" => "669" "paginaFinal" => "681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11547722" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642009004679" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0150" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperfibrinolysis resulting from clotting activation in patients with different degrees of cirrhosis. The CALC Group. Coagulation abnormalities in liver cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Violi" 1 => "D. Ferro" 2 => "S. Basili" 3 => "C. Quintarelli" 4 => "A. Musca" 5 => "C. Cordova" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hepatology" "fecha" => "1993" "volumen" => "17" "paginaInicial" => "78" "paginaFinal" => "83" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0155" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Procoagulant versus anticoagulant factors in cirrhotic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. El Bokl" 1 => "A. Shawky" 2 => "G.S. Riad" 3 => "H.S. Abdel Fattah" 4 => "H. Shalaby" 5 => "A. Nady" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajg.2014.08.003" "Revista" => array:6 [ "tituloSerie" => "Arab J Gastroenterol" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "123" "paginaFinal" => "129" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25249231" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0160" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coagulation abnormalities in patients with chronic liver disease in Pakistan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.A. Siddiqui" 1 => "M. Ahmed" 2 => "M.H. Ghani" 3 => "M.A. Memon" 4 => "G. Mustafa" 5 => "M.A. Ghori" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pak Med Assoc" "fecha" => "2011" "volumen" => "61" "paginaInicial" => "363" "paginaFinal" => "367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21465974" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0165" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Lisman" 1 => "R.J. Porte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2010-02-261891" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2010" "volumen" => "116" "paginaInicial" => "878" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20400681" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0170" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Upper gastrointestinal bleeding in patients with liver cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O.O. Odelowo" 1 => "D.T. Smoot" 2 => "K. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Natl Med Assoc" "fecha" => "2002" "volumen" => "94" "paginaInicial" => "712" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12152928" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0175" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.C. Rockey" 1 => "S.H. Caldwell" 2 => "Z.D. Goodman" 3 => "R.C. Nelson" 4 => "A.D. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.22742" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2009" "volumen" => "49" "paginaInicial" => "1017" "paginaFinal" => "1044" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19243014" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0180" "etiqueta" => "[8]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired coagulation disorders: revisited using global coagulation/anticoagulation testing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Tripodi" 1 => "V. Chantarangkul" 2 => "P.M. Mannucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2141.2009.07833.x" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2009" "volumen" => "147" "paginaInicial" => "77" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19659548" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0185" "etiqueta" => "[9]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.B. Segal" 1 => "W.H. Dzik" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transfusion (Paris)" "fecha" => "2005" "volumen" => "45" "paginaInicial" => "1413" "paginaFinal" => "1425" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0190" "etiqueta" => "[10]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changing concepts of cirrhotic coagulopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Tripodi" 1 => "M. Primignani" 2 => "P.M. Mannucci" 3 => "S.H. Caldwell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2016.498" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2017" "volumen" => "112" "paginaInicial" => "274" "paginaFinal" => "281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27801884" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0195" "etiqueta" => "[11]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delicate balance of bleeding and thrombosis in end-stage liver disease and liver transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.H. Saner" 1 => "R.K. Gieseler" 2 => "H. Akiz" 3 => "A. Canbay" 4 => "K. Gorlinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000354400" "Revista" => array:6 [ "tituloSerie" => "Digestion" "fecha" => "2013" "volumen" => "88" "paginaInicial" => "135" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24008288" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0200" "etiqueta" => "[12]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.G. Giannini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2006.02889.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2006" "volumen" => "23" "paginaInicial" => "1055" "paginaFinal" => "1065" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16611265" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0205" "etiqueta" => "[13]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.G. Giannini" 1 => "A. Greco" 2 => "S. Marenco" 3 => "E. Andorno" 4 => "U. Valente" 5 => "V. Savarino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2010.06.018" "Revista" => array:6 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "899" "paginaFinal" => "902" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20601131" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0210" "etiqueta" => "[14]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of fibrinogen in trauma-induced coagulopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Fries" 1 => "W.Z. Martini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aeq161" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2010" "volumen" => "105" "paginaInicial" => "116" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20627882" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0215" "etiqueta" => "[15]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coagulation studies as a prognostic index in acute liver failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.W. Dymock" 1 => "J.S. Tucker" 2 => "I.L. Woolf" 3 => "L. Poller" 4 => "J.M. Thomson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2141.1975.tb01836.x" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "1975" "volumen" => "29" "paginaInicial" => "385" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1201157" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0220" "etiqueta" => "[16]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haemostatic balance in cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Baccouche" 1 => "A. Labidi" 2 => "M. Fekih" 3 => "S. Mahjoub" 4 => "H. Kaabi" 5 => "S. Hmida" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Blood Coagul Fibrinolysis" "fecha" => "2017" "volumen" => "28" "paginaInicial" => "139" "paginaFinal" => "144" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0225" "etiqueta" => "[17]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Tripodi" 1 => "M. Primignani" 2 => "V. Chantarangkul" 3 => "A. Dell’Era" 4 => "M. Clerici" 5 => "R. de Franchis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gastroenterology" "fecha" => "2009" "volumen" => "137" "paginaInicial" => "2105" "paginaFinal" => "2111" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0230" "etiqueta" => "[18]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection of the imbalance of procoagulant versus anticoagulant factors in cirrhosis by a simple laboratory method" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Tripodi" 1 => "M. Primignani" 2 => "L. Lemma" 3 => "V. Chantarangkul" 4 => "A. Dell’Era" 5 => "F. Iannuzzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.23653" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2010" "volumen" => "52" "paginaInicial" => "249" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20578143" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0235" "etiqueta" => "[19]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: a randomized, controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Bosch" 1 => "D. Thabut" 2 => "A. Albillos" 3 => "N. Carbonell" 4 => "J. Spicak" 5 => "J. Massard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.22216" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "1604" "paginaFinal" => "1614" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18393319" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0240" "etiqueta" => "[20]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of a single bolus administration of recombinant factor VIIa in liver transplantation due to chronic liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Planinsic" 1 => "J. van der Meer" 2 => "G. Testa" 3 => "L. Grande" 4 => "A. Candela" 5 => "R.J. Porte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lt.20458" "Revista" => array:6 [ "tituloSerie" => "Liver Transpl" "fecha" => "2005" "volumen" => "11" "paginaInicial" => "895" "paginaFinal" => "900" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16035081" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0245" "etiqueta" => "[21]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Tripodi" 1 => "F. Salerno" 2 => "V. Chantarangkul" 3 => "M. Clerici" 4 => "M. Cazzaniga" 5 => "M. Primignani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20569" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "553" "paginaFinal" => "558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15726661" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0250" "etiqueta" => "[22]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coagulation abnormalities in the cirrhotic patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Mucino-Bermejo" 1 => "R. Carrillo-Esper" 2 => "M. Uribe" 3 => "N. Mendez-Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2013" "volumen" => "12" "paginaInicial" => "713" "paginaFinal" => "724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24018489" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0255" "etiqueta" => "[23]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.H. Caldwell" 1 => "M. Hoffman" 2 => "T. Lisman" 3 => "B.G. Macik" 4 => "P.G. Northup" 5 => "K.R. Reddy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21303" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2006" "volumen" => "44" "paginaInicial" => "1039" "paginaFinal" => "1046" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17006940" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0260" "etiqueta" => "[24]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanism of the abnormal vitamin K-dependent gamma-carboxylation process in human hepatocellular carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.G. Huisse" 1 => "M. Leclercq" 2 => "J. Belghiti" 3 => "J.F. Flejou" 4 => "J.W. Suttie" 5 => "A. Bezeaud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(19940901)74:5<1533::aid-cncr2820740507>3.0.co;2-v" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1994" "volumen" => "74" "paginaInicial" => "1533" "paginaFinal" => "1541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7520347" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0265" "etiqueta" => "[25]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The coagulopathy of liver disease: does vitamin K help?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.F. Saja" 1 => "A.A. Abdo" 2 => "F.M. Sanai" 3 => "S.A. Shaikh" 4 => "A.G. Gader" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MBC.0b013e32835975ed" "Revista" => array:6 [ "tituloSerie" => "Blood Coagul Fibrinolysis" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "10" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23080365" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0270" "etiqueta" => "[26]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.A. Liebman" 1 => "B.C. Furie" 2 => "M.J. Tong" 3 => "R.A. Blanchard" 4 => "K.J. Lo" 5 => "S.D. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198405313102204" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1984" "volumen" => "310" "paginaInicial" => "1427" "paginaFinal" => "1431" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6201741" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0275" "etiqueta" => "[27]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential effects of vitamin K1 on AFP and DCP levels in patients with unresectable HCC and in HCC cell lines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.I. Carr" 1 => "Z. Wang" 2 => "M. Wang" 3 => "G. Wei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-010-1521-x" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2011" "volumen" => "56" "paginaInicial" => "1876" "paginaFinal" => "1883" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21188521" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0280" "etiqueta" => "[28]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: a comparison of AFP, DCP, and AFP-L3" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.L. Volk" 1 => "J.C. Hernandez" 2 => "G.L. Su" 3 => "A.S. Lok" 4 => "J.A. Marrero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer Biomark" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "79" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17522429" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001800000004/v3_201908230828/S1665268119300717/v3_201908230828/en/main.assets" "Apartado" => array:4 [ "identificador" => "78265" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001800000004/v3_201908230828/S1665268119300717/v3_201908230828/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300717?idApp=UINPBA00004N"]

Statistics

Original article

Asma Labidia,

Corresponding author

asma.labidy@gmail.com
asma.labidi@fmt.utm.tn

Corresponding author at: Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia.

, Héla Baccoucheb, Monia Fekiha, Sonia Mahjoubb, Nadia BenMustaphaa, Meriem Serghinia, Neila BenRomdhaneb, Jalel Boubakera

a Department of Gastroenterology and Hepatology, Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

b Department of Hematology, Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Read

3474

Times
was read the article

725

Total PDF

2749

Total HTML

Share statistics

 array:24 [
  "pii" => "S1665268119300717"
  "issn" => "16652681"
  "doi" => "10.1016/j.aohep.2018.12.007"
  "estado" => "S300"
  "fechaPublicacion" => "2019-07-01"
  "aid" => "63"
  "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Ann Hepatol. 2019;18:627-32"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 491
    "formatos" => array:3 [
      "EPUB" => 28
      "HTML" => 319
      "PDF" => 144
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1665268119300729"
    "issn" => "16652681"
    "doi" => "10.1016/j.aohep.2018.12.008"
    "estado" => "S300"
    "fechaPublicacion" => "2019-07-01"
    "aid" => "64"
    "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Ann Hepatol. 2019;18:633-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 393
      "formatos" => array:3 [
        "EPUB" => 34
        "HTML" => 178
        "PDF" => 181
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Folic acid ameliorates homocysteine-induced angiogenesis and portosystemic collaterals in cirrhotic rats"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "633"
          "paginaFinal" => "639"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1392
              "Ancho" => 2083
              "Tamanyo" => 273077
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Splanchnic hemodynamic parameters of cirrhotic rats with vehicle &#40;V&#41;&#44; homocysteine &#40;H&#41;&#44; homocysteine plus folic acid &#40;H<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>F&#41; or folic acid &#40;F&#41; administration&#46; The number of each group was 8&#44; 7&#44; 5&#44; 8&#44; respectively&#46; As compared with the vehicle group&#44; homocysteine significantly increased SMA flow &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#41;&#44; which was tended to be reduced by folic acid&#46; SMA&#58; superior mesenteric artery&#59; PV&#58; portal vein&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Hsin-Ling Ho, Ming-Hung Tsai, Yu-Hsin Hsieh, Teh-Ia Huo, Ching-Chih Chang, Fa-Yauh Lee, Hui-Chun Huang, Ming-Chih Hou, Shou-Dong Lee"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Hsin-Ling"
              "apellidos" => "Ho"
            ]
            1 => array:2 [
              "nombre" => "Ming-Hung"
              "apellidos" => "Tsai"
            ]
            2 => array:2 [
              "nombre" => "Yu-Hsin"
              "apellidos" => "Hsieh"
            ]
            3 => array:2 [
              "nombre" => "Teh-Ia"
              "apellidos" => "Huo"
            ]
            4 => array:2 [
              "nombre" => "Ching-Chih"
              "apellidos" => "Chang"
            ]
            5 => array:2 [
              "nombre" => "Fa-Yauh"
              "apellidos" => "Lee"
            ]
            6 => array:2 [
              "nombre" => "Hui-Chun"
              "apellidos" => "Huang"
            ]
            7 => array:2 [
              "nombre" => "Ming-Chih"
              "apellidos" => "Hou"
            ]
            8 => array:2 [
              "nombre" => "Shou-Dong"
              "apellidos" => "Lee"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300729?idApp=UINPBA00004N"
    "url" => "/16652681/0000001800000004/v3_201908230828/S1665268119300729/v3_201908230828/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1665268119300687"
    "issn" => "16652681"
    "doi" => "10.1016/j.aohep.2018.12.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-07-01"
    "aid" => "60"
    "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Ann Hepatol. 2019;18:620-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 452
      "formatos" => array:3 [
        "EPUB" => 20
        "HTML" => 248
        "PDF" => 184
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Advantages of adipose tissue stem cells over CD34<span class="elsevierStyleSup">&#43;</span> mobilization to decrease hepatic fibrosis in Wistar rats"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "620"
          "paginaFinal" => "626"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Fig&#46; 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1965
              "Ancho" => 2083
              "Tamanyo" => 189004
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Quantification of collagen in liver tissue and immunohistochemical analysis of the groups evaluated after treatment at 16 weeks&#46; &#40;A&#41; Quantification of collagen percentage stained with sirius red&#46; &#40;B&#41; Immunohistochemistry proliferating cell nuclear antigen &#40;PCNA&#41; in liver tissue&#58; evaluation of staining intensities&#46; Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; Significant differences in both analysis&#46; &#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; &#42;&#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Marcela M&#46; De Luna-Saldivar, Iv&#225;n A&#46; Marino-Martinez, Mois&#233;s A&#46; Franco-Molina, Lydia G&#46; Rivera-Morales, Gabriela Alarc&#243;n-Galv&#225;n, Paula Cordero-P&#233;rez, Augusto Rojas-Mart&#237;nez, Cristina Rodr&#237;guez-Padilla, Linda E&#46; Mu&#241;oz-Espinosa"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Marcela M&#46;"
              "apellidos" => "De Luna-Saldivar"
            ]
            1 => array:2 [
              "nombre" => "Iv&#225;n A&#46;"
              "apellidos" => "Marino-Martinez"
            ]
            2 => array:2 [
              "nombre" => "Mois&#233;s A&#46;"
              "apellidos" => "Franco-Molina"
            ]
            3 => array:2 [
              "nombre" => "Lydia G&#46;"
              "apellidos" => "Rivera-Morales"
            ]
            4 => array:2 [
              "nombre" => "Gabriela"
              "apellidos" => "Alarc&#243;n-Galv&#225;n"
            ]
            5 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Cordero-P&#233;rez"
            ]
            6 => array:2 [
              "nombre" => "Augusto"
              "apellidos" => "Rojas-Mart&#237;nez"
            ]
            7 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Rodr&#237;guez-Padilla"
            ]
            8 => array:2 [
              "nombre" => "Linda E&#46;"
              "apellidos" => "Mu&#241;oz-Espinosa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300687?idApp=UINPBA00004N"
    "url" => "/16652681/0000001800000004/v3_201908230828/S1665268119300687/v3_201908230828/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "The relationship between coagulation disorders and the risk of bleeding in cirrhotic patients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "627"
        "paginaFinal" => "632"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Asma Labidi, H&#233;la Baccouche, Monia Fekih, Sonia Mahjoub, Nadia BenMustapha, Meriem Serghini, Neila BenRomdhane, Jalel Boubaker"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Asma"
            "apellidos" => "Labidi"
            "email" => array:2 [
              0 => "asma.labidy@gmail.com"
              1 => "asma.labidi@fmt.utm.tn"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "H&#233;la"
            "apellidos" => "Baccouche"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Monia"
            "apellidos" => "Fekih"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Sonia"
            "apellidos" => "Mahjoub"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Nadia"
            "apellidos" => "BenMustapha"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Meriem"
            "apellidos" => "Serghini"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Neila"
            "apellidos" => "BenRomdhane"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Jalel"
            "apellidos" => "Boubaker"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Department of Gastroenterology and Hepatology&#44; Rabta Hospital&#44; Faculty of Medicine of Tunis&#44; University of Tunis El Manar&#44; Tunis&#44; Tunisia"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Hematology&#44; Rabta Hospital&#44; Faculty of Medicine of Tunis&#44; University of Tunis El Manar&#44; Tunis&#44; Tunisia"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author at&#58; Rabta Hospital&#44; Faculty of Medicine of Tunis&#44; University of Tunis El Manar&#44; Jabbari Street&#44; 1007 Tunis&#44; Tunisia&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 975
            "Ancho" => 2342
            "Tamanyo" => 61728
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparison of ETP ratio between &#40;H&#43;&#41; patients and controls &#40;A&#41;&#44; and between &#40;H&#43;&#41; and &#40;H&#8722;&#41; patients &#40;B&#41;&#46; H&#43;&#58; cirrhotic patients who experienced bleeding&#59; H&#8722;&#58; cirrhotic patients who did not experienced bleeding&#59; ETP&#58; endogenous thrombin potential&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bleeding often complicates the clinical course of cirrhosis&#46; The most frequent and potentially life-threatening site of bleeding is the gastrointestinal tract&#46; It could result from a variety of lesions including gastro-esophageal varices and portal hypertensive gastropathy or other lesions seen in the general population like esophagitis&#44; Mallory-Weiss tears and peptic ulcer disease&#46; Mortality rates related to gastrointestinal bleeding are high&#59; up to 30&#37; of initial variceal bleeding episodes are fatal <a class="elsevierStyleCrossRef" href="#bib0145">&#91;1&#93;</a>&#46; Patients with cirrhosis may also experience cutaneous or mucosa-associated bleeding including bruising&#44; purpura&#44; epistaxis&#44; gingival bleeding&#44; menorrhagia&#44; and bleeding associated with invasive procedures such as liver biopsy&#46; For long&#44; this increased hemorrhagic risk has been thought to be related to acquired hemostatic disorders in cirrhotic patients&#46; In fact&#44; liver synthesizes almost all coagulation factors with the exception of factor VIII&#46; It has been thought that the reduced synthesis of clotting factors was responsible for abnormal conventional laboratory tests exploring global clotting activation&#44; such as prothrombin time &#40;PT&#41; and activated partial thromboplastin &#40;aPTT&#41;&#46; However it has been noted that despite prolonged PT and aPTT&#44; many cirrhotic patients do not experience bleeding even after liver biopsy or other potentially hemorrhagic procedures <a class="elsevierStyleCrossRef" href="#bib0150">&#91;2&#93;</a>&#46; Furthermore&#44; some cirrhotic patients do experience thromboembolic events despite abnormal conventional laboratory tests&#46; Thus far&#44; only few studies have investigated the impact of coagulation disorders on bleeding risk in cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0155">&#91;3&#44;4&#93;</a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This study aims to assess the relationship between hemostatic disorders and the risk of bleeding in cirrhotic patients through investigating hemostatic balance in cirrhotic patients with and without bleeding in comparison with controls&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study was performed in accordance with the Declaration of Helsinki of the World Medical Association and was approved by the local ethics committee&#46; All patients gave their informed consent prior to inclusion in the study&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0045">Patient population and study design</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fifty-one cirrhotic patients constituted the group of cases and 50 healthy controls matched for age and sex were included in a cross-sectional study&#46; Data regarding bleeding episodes&#44; characteristics of cirrhosis and medication were abstracted from medical records&#46; The severity of cirrhosis was estimated according to Child Turcotte Pugh score&#46; Patients who had bleeding episodes within 2 months before or after inclusion were identified&#46; For each of these patients&#44; site and severity of bleeding were determined&#46; Patients who experienced bleeding with deglobulisation &#40;fall of the hemoglobin of 2<span class="elsevierStyleHsp" style=""></span>g&#47;dl or more&#41; requiring or not a transfusion were considered as having severe hemorrhage&#46; Exclusion criteria were hepatocellular carcinoma or any other malignancy&#44; bacterial infection&#44; chronic inflammatory disease&#44; nephrotic syndrome&#44; renal failure&#44; known inherited coagulation abnormalities and use of anticoagulant or anti-platelet drugs&#46; Patients were divided into two groups&#58; &#40;H&#43;&#41; group included patients who experienced bleeding episodes and &#40;H&#8722;&#41; group included patients who did not&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0050">Blood collection</span><p id="par0025" class="elsevierStylePara elsevierViewall">Blood sample was drawn through venipuncture into plastic tubes containing 3&#46;2&#37; sodium citrate as an anticoagulant in the proportion of one to nine parts of anticoagulant&#47;blood&#46; Poor platelet plasma &#40;PPP&#41; was obtained after a double blood centrifugation at 2500<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">g</span> for 15<span class="elsevierStyleHsp" style=""></span>min&#46; PPP was aliquoted and frozen at &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C until coagulation tests were performed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0055">Laboratory tests</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0060">Conventional laboratory tests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The prothrombin time &#40;PT&#41; and activated partial thromboplastin time &#40;aPTT&#41; were measured&#44; respectively&#44; with the human thromboplastin &#40;neoplastin&#44; STAGO&#41; and the automated APTT reagent &#40;APTT&#44; STAGO&#41;&#46; The fibrinogen was measured with &#40;STA fibrinogen&#44; STAGO&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0065">Pro and anticoagulant factors</span><p id="par0035" class="elsevierStylePara elsevierViewall">The pro and anticoagulant factor activities were determined as functional activities using STAGO reagents&#58; Factor VIII and XII activities were measured with standard aPTT based clotting assays &#40;respectively with DEFICIENT VIII and IMMUNODEF XII&#41;&#46; Factor VII&#44; factor V and factor II activities were measured with PT based clotting assays &#40;respectively with DEFICIENT VII&#44; DEFICIENT V&#44; IMMUNODEF II&#41;&#46; Protein C &#40;PC&#41; and Protein S &#40;PS&#41; activities were measured using clotting assays &#40;STACLOT PC and STACLOT PS&#41;&#46; Antithrombin &#40;AT&#41; activity was determined using chromogenic assay &#40;STACHROM AT&#41;&#46; All tests were performed on STA COMPACT MAX &#40;STAGO&#59; Asni&#232;res France&#41;&#46; Platelet count was performed on the hematology analyzer &#40;SYSMEX XT 2000i&#59; Cobe&#44; Japan&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0070">Thrombin generation</span><p id="par0040" class="elsevierStylePara elsevierViewall">Thrombin generation &#40;TG&#41; was measured by means of calibrated automated thrombin method &#40;thrombiniscope-Thermosystem&#41;&#46; The coagulation was triggered in the PPP after addition of tissue factor 1<span class="elsevierStyleHsp" style=""></span>pmol&#47;L and phospholipids &#40;PPP reagent low-STAGO&#41; into two steps&#58; in the absence then in the presence of protein C activator &#40;PROTAC&#59; STACLOT PC STAGO&#41;&#46; Registration of the thrombin generated over time was carried out with a fluorogenic substrate &#40;FLUCAT&#44; STAGO&#41;&#46; The TG was expressed as endogenous thrombin potential &#40;ETP&#41; in nmol<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>min&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0075">Hemostatic balance</span><p id="par0045" class="elsevierStylePara elsevierViewall">Hemostatic balance was assessed by means of procoagulant to anticoagulant factor ratios and ETP ratio with&#47;without PC activator&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Statistical Package for Social Science &#40;SPSS&#41; software version 21&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#46; New York&#44; USA&#41; was used for analysis of data&#46; Data were summarized as mean and percentage&#46; Study groups were compared using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test for qualitative variables&#46; Student&#39;s <span class="elsevierStyleItalic">t</span> and ANOVA tests were used for analysis of parametric data&#46; Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> and Kruskal&#8211;Wallis <span class="elsevierStyleItalic">H</span> tests were used for analysis of non-parametric data&#46; <span class="elsevierStyleItalic">p</span>-Value less than or equal to 0&#46;05 was considered significant&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Mean age of patients at inclusion was 57&#46;8 years &#40;16&#8211;91 years&#41;&#46; Mean age at diagnosis of cirrhosis was 55 years &#40;6&#8211;88 years&#41;&#46; There were 24 males and 27 females&#46; Major etiology of cirrhosis was viral hepatitis &#40;64&#46;7&#37;&#41;&#46; Patients were categorized according to Child&#8211;Pugh score as class A in 14 patients &#40;27&#46;5&#37;&#41;&#44; class B in 22 patients &#40;43&#46;2&#37;&#41;&#44; and class C in 15 patients &#40;29&#46;3&#37;&#41;&#46; &#40;H&#43;&#41; group included 9 patients &#40;17&#46;6&#37;&#41;&#46; Bleeding episodes were variceal hemorrhage &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; gastrointestinal bleeding secondary to gastric &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and duodenal &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; ulcers and gingivorrhagia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Hemorrhage was judged mild to moderate in 6 patients and severe in 3 others&#46; Both patient groups were comparable regarding age&#44; sex and Child&#8211;Pugh score&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Obviously&#44; as regards controls&#44; no bleeding episodes occurred within 2 months before or after inclusion&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0090">Conventional laboratory tests</span><p id="par0065" class="elsevierStylePara elsevierViewall">There was no significant difference in mean levels of PT&#44; aPTT and fibrinogen between &#40;H&#43;&#41; and &#40;H&#8722;&#41; groups&#46; Platelet count was significantly lower in &#40;H&#43;&#41; patients than in &#40;H&#8722;&#41; patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0095">Procoagulant and anticoagulant factors</span><p id="par0070" class="elsevierStylePara elsevierViewall">Mean levels of pro-and anticoagulant factors were significantly lower in cirrhotic patients who experienced bleeding episodes &#40;H&#43;&#41; than in controls&#46; However&#44; factor VIII was significantly higher in cirrhotic patients than in controls &#40;166&#37; vs&#46; 94&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;045&#41;&#46; There was no significant difference between both &#40;H&#43;&#41; and &#40;H&#8722;&#41; groups as regards levels of pro- and anticoagulant factors &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0100">Thrombin generation</span><p id="par0075" class="elsevierStylePara elsevierViewall">There was no significant difference between &#40;H&#43;&#41; patients and controls as regards ETP mean level without PC activator &#40;716&#46;1 vs&#46; 811<span class="elsevierStyleHsp" style=""></span>nmol<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>min respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#41;&#46; In the presence of PC activator&#44; ETP was surprisingly higher in &#40;H&#43;&#41; patients than in controls &#40;725 vs&#46; 387<span class="elsevierStyleHsp" style=""></span>nmol<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>min&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">However&#44; there was no significant difference between patient groups as regards ETP with and without PC activator&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;4</span><span class="elsevierStyleSectionTitle" id="sect0105">Hemostatic balance</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;4&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0110">The ratios of pro- to anticoagulant factors</span><p id="par0085" class="elsevierStylePara elsevierViewall">Compared with controls&#44; VIII&#47;anticoagulant factors &#40;VIII&#47;PC&#44; VIII&#47;PS&#44; VIII&#47;AT&#41;&#44; VII&#47;PC and XII&#47;PC were significantly higher in &#40;H&#43;&#41; patients&#46; All other ratios were roughly at the same levels&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">No significant difference as regards all ratios between patients who experienced bleeding &#40;H&#43;&#41; and those who did not &#40;H&#8722;&#41; was detected &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3&#46;4&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0115">ETP ratio</span><p id="par0095" class="elsevierStylePara elsevierViewall">ETP ratio with&#47;without PC activator was significantly higher in &#40;H&#43;&#41; patients than in controls &#40;0&#46;97 vs&#46; 0&#46;51&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">However&#44; there was no significant difference between patient groups as regards ETP ratio &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p></span></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The current study showed that the hemostatic balance assessed by ratios of pro- to anticoagulant factors and ETP ratio with&#47;without PC activator was in favor of a hypercoagulability state even in cirrhotic patients who experienced bleeding events&#46; When comparing both patient groups&#44; cirrhotic patients who had bleeding generated roughly as much thrombin as those who had not&#46; To our knowledge&#44; there were no published studies investigating the impact of thrombin generation assay in assessing the bleeding risk in cirrhosis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">However&#44; the main limitation of this study is the small number of cirrhotic patients who experienced bleeding&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The bleeding tendency in cirrhotic patients namely in those with advanced liver disease was supported by many clinical observations <a class="elsevierStyleCrossRef" href="#bib0165">&#91;5&#93;</a>&#46; The most relevant hemorrhagic events in such patients result from esophageal varices rupture and portal hypertensive gastropathy <a class="elsevierStyleCrossRef" href="#bib0170">&#91;6&#93;</a>&#46; Bleeding may occur also from the same lesions seen in the general population such as peptic ulcer&#44; epistaxis&#44; gingivorrhagia&#44; bruising or from invasive procedures&#46; In our study&#44; variceal bleeding was the most common site of hemorrhage as it occurred in two-thirds of patients&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Historically&#44; hemostatic abnormalities due to liver failure such as prolonged PT and aPTT were assumed to reflect bleeding disorders that frequently occur in cirrhotic patients&#46; Thus&#44; PT has frequently been corrected by means of fresh frozen plasma prior to liver biopsy or other potentially hemorrhagic procedures <a class="elsevierStyleCrossRef" href="#bib0175">&#91;7&#93;</a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the present study&#44; there was not any significant difference between patients who experienced bleeding and those who did not as regards PT and aPTT mean levels&#46; Our results are in accordance with those of many papers suggesting these conventional tests are not as good at predicting bleeding in acquired as compared with congenital coagulopathies <a class="elsevierStyleCrossRef" href="#bib0180">&#91;8&#93;</a>&#46; In fact&#44; Segal et al&#46; found no evidence to conclude that prolonged PT could predict bleeding during invasive diagnostic procedures <a class="elsevierStyleCrossRef" href="#bib0185">&#91;9&#93;</a>&#46; Furthermore&#44; Tripodi noted that&#44; paradoxically&#44; cirrhotic patients with near-normal PT could bleed whereas patients with relatively abnormal PT commonly did not <a class="elsevierStyleCrossRef" href="#bib0190">&#91;10&#93;</a>&#46; The lack of its bleeding predictive power can best be explained by the fact that only the procoagulant but not the anticoagulant activity &#40;PC&#44; PS&#44; AT&#41; is being reflected by PT <a class="elsevierStyleCrossRef" href="#bib0195">&#91;11&#93;</a>&#46; Since both procoagulant and anticoagulant factors are decreased in cirrhosis&#44; PT and aPTT could not represent the balance between pro-and anticoagulant factors <a class="elsevierStyleCrossRef" href="#bib0165">&#91;5&#93;</a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">With regard to platelet count assessed in the present study&#44; patients who experienced bleeding had significantly lower levels than patients who did not &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Our results were in agreement with those of El Bokl et al&#46; where platelet count was found to be significantly lower in cirrhotic patients who experienced hematemesis and melena than those who did not have bleeding episodes &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; <a class="elsevierStyleCrossRef" href="#bib0155">&#91;3&#93;</a>&#46; These findings could be supported by the multiple quantitative and qualitative alterations that could affect platelets in patients with chronic liver disease&#46; Increased platelet sequestration in the spleen caused by portal hypertension and decreased thrombopoietin production by the diseased liver are main mechanisms of thrombocytopenia in cirrhotic patients <a class="elsevierStyleCrossRef" href="#bib0200">&#91;12&#93;</a>&#46; Besides thrombocytopenia&#44; defective platelet function has also been found since adhesion&#44; aggregation and then capacity to support thrombin generation are impaired in cirrhotic patients&#46; These findings were supported by several clinical observations showing that a platelet count &#60;60&#44;000&#47;mm<span class="elsevierStyleSup">3</span> was associated with a significantly increased risk of bleeding related to invasive procedures <a class="elsevierStyleCrossRef" href="#bib0205">&#91;13&#93;</a>&#46; Thus&#44; platelet count seems to be more reliable than other hemostatic conventional tests &#40;TP or aPTT&#41; in assessing bleeding risk&#46; Although there is no prospective studies determining the threshold platelet count for prophylactic transfusion in cirrhotic patients&#44; AASLD guidelines for liver biopsy recommend consideration of platelet transfusion prior to liver biopsy for a platelet count &#60;50&#44;000&#8211;60&#44;000&#47;mm<span class="elsevierStyleSup">3</span> &#40;Class I level C&#41; <a class="elsevierStyleCrossRef" href="#bib0175">&#91;7&#93;</a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the current study&#44; there was not any difference between &#40;H&#43;&#41; and &#40;H&#8722;&#41; patients with regard to plasma fibrinogen level&#46; However&#44; Siddiqui et al&#46; found significant correlation for decreased fibrinogen level with gastrointestinal bleeding in cirrhotic patients &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;47&#59; 95&#37; CI&#44; 0&#46;64&#8211;3&#46;35&#41; <a class="elsevierStyleCrossRef" href="#bib0160">&#91;4&#93;</a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In fact&#44; hypofibrinogenemia which is frequently seen in patients with advanced cirrhosis is thought to increase bleeding risk since fibrinogen serves both as a precursor of fibrin and a mediator of platelet aggregation <a class="elsevierStyleCrossRef" href="#bib0210">&#91;14&#93;</a>&#46; Bleeding risk is considered particularly high when fibrinogen levels are below 1<span class="elsevierStyleHsp" style=""></span>g&#47;L <a class="elsevierStyleCrossRef" href="#bib0215">&#91;15&#93;</a>&#46; In the present study&#44; our results as regards fibrinogen levels could be explained by the fact that the majority of patients had stable liver disease&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In the present study&#44; procoagulant &#40;II&#44; V&#44; VII and XII&#41; and anti-coagulant factors &#40;PC&#44; PS and AT&#41; were significantly lower in cirrhotic patients who had bleeding than in controls&#46; However&#44; FVIII was markedly increased in the former group&#46; Several previous studies were in agreement with our results regardless of bleeding or thrombotic status of cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0220">&#91;16&#8211;18&#93;</a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">When comparing &#40;H&#43;&#41; and &#40;H&#8722;&#41; patients&#44; no difference in levels of pro-and anticoagulant factors was detected&#46; In line with our results&#44; El Bokl et al&#46; showed no significant difference between both patient groups as regards FVIII level&#46; However&#44; paradoxically&#44; PC was significantly lower in cirrhotic patients who experienced bleeding in comparison with those who did not &#40;36&#46;4&#37; vs&#46; 65&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;018&#41; <a class="elsevierStyleCrossRef" href="#bib0155">&#91;3&#93;</a>&#46; These findings suggest that bleeding events in cirrhotic patients are not related to plasma levels of coagulation factors&#46; Indeed&#44; randomized controlled trials provide evidence against effectiveness of recombinant activated factor VII infusion in controlling bleeding from varices or during hepatectomy <a class="elsevierStyleCrossRefs" href="#bib0235">&#91;19&#44;20&#93;</a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In the present study&#44; regarding hemostatic balance&#44; VIII&#47;anticoagulant factors &#40;VIII&#47;PC&#59; VIII&#47;PS and VIII&#47;AT&#41;&#44; VII&#47;PC and XII&#47;PC were significantly higher in &#40;H&#43;&#41; patients than in controls&#46; All other ratios were roughly at the same levels between &#40;H&#43;&#41; patients and controls&#46; Similarly&#44; previous studies showed that ratios pro- to anticoagulant factors &#40;II&#47;PC&#44; V&#47;PC&#44; VIII&#47;PC and VIII&#47;AT&#41; were significantly higher in cirrhotic patients than in controls <a class="elsevierStyleCrossRefs" href="#bib0220">&#91;16&#44;17&#44;21&#93;</a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In the current study&#44; all ratios of pro- to anticoagulant factors were at the same levels between both patient groups&#46; However&#44; El Bokl et al&#46; showed paradoxically a significant higher level of FVIII&#47;PC in cirrhotic patients who had bleeding events than in patients who had not <a class="elsevierStyleCrossRef" href="#bib0155">&#91;3&#93;</a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">With regard to thrombin generation assessed in the current study&#44; there was no difference across controls and patient groups&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">After activation of PC&#44; ETP ratio was significantly higher in &#40;H&#43;&#41; patients than in controls &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41;&#46; These findings were in agreement with those of Tripodi et al&#46; suggesting a state of resistance to the anticoagulant effect of activated PC in cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0225">&#91;17&#44;18&#93;</a>&#46; This &#8220;hypercoagulability status&#8221; could even have a protective effect against bleeding in cirrhotic patients&#46; In the same context&#44; ETP ratio did not reach statistical significance between both patient groups&#46; This finding provides an additional argument against the traditional tenet holding that coagulation disorders detected in cirrhotic patients are predictors of bleeding&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">It appears that gastrointestinal bleeding may be explained by hemodynamic alterations related to portal hypertension&#46; Advanced liver disease&#44; large varices&#44; variceal wall tension and the presence of red wale marking have been reported as risk factors for variceal bleeding in cirrhotic patients <a class="elsevierStyleCrossRef" href="#bib0250">&#91;22&#93;</a>&#46; Endothelial dysfunctions&#44; bacterial infections and renal failure may also contribute to gastrointestinal bleeding <a class="elsevierStyleCrossRef" href="#bib0255">&#91;23&#93;</a>&#46; Other bleeding events such as epistaxis&#44; gingivorrhagia and bruising may be explained by thrombocytopenia&#44; which is in turn mainly due to portal hypertension <a class="elsevierStyleCrossRef" href="#bib0255">&#91;23&#93;</a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Before concluding&#44; it is worth noting that in patients with chronic liver disease&#44; vitamin k deficiency is one of the main factors implicated in coagulation disorders described above&#46; Indeed&#44; vitamin K deficiency may result in&#44; not only decreased synthesis of coagulation factors but also in producing under-carboxylated precursors of these proteins that are functionally inactive&#46; These proteins are known as proteins induced by vitamin K absence &#40;PIVKA&#41; such as undercaboxylated prothrombine &#40;PIVK-II&#41; which has been shown to be secreted by hepatocellular carcinoma cells in cirrhotic patients <a class="elsevierStyleCrossRefs" href="#bib0260">&#91;24&#44;25&#93;</a>&#46; Although it has been reported in some previous studies that the administration of vitamin K in such patients did not improve coagulation disorders&#44; data regarding the sensitivity of under-carboxylated prothrombin are still conflicting <a class="elsevierStyleCrossRefs" href="#bib0270">&#91;26&#44;27&#93;</a>&#46; Hence&#44; we could speculate that it would probably be wise not to administer vitamin K in cirrhotic patients in order to prevent a significant decrease of the level of undercarboxylated prothrombin which may play a role in the early diagnosis of hepatocellular carcinoma in such patients <a class="elsevierStyleCrossRef" href="#bib0280">&#91;28&#93;</a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In conclusion&#44; although our findings should be interpreted cautiously due to the small number of &#40;H&#43;&#41; patients&#44; they may support the concept that abnormal conventional laboratory tests such as prolonged PT and aPTT do not correlate with bleeding risk in cirrhotic patients&#46; However&#44; platelet count seems to be a better predictor of bleeding than PT and aPTT&#46; The hemostatic balance is shifted toward a hypercoagulability state even in cirrhotic patients who experienced bleeding&#46; We surmise that gastrointestinal bleeding in such patients is mainly hemodynamic due to portal hypertension&#46; Further studies should take into account the fibrinolytic system&#46; In fact&#44; hyperfibrinolysis has been reported in some cases as a cause of bleeding in cirrhotic patients&#44; although this concept remains controversial <a class="elsevierStyleCrossRef" href="#bib0190">&#91;10&#93;</a>&#46;<span class="elsevierStyleDefList"><span class="elsevierStyleSectionTitle" id="sect0125">Abbreviations</span><span class="elsevierStyleDefTerm">ETP</span><span class="elsevierStyleDefDescription"><p id="par0190" class="elsevierStylePara elsevierViewall">endogenous thrombin potential</p></span><span class="elsevierStyleDefTerm">PC</span><span class="elsevierStyleDefDescription"><p id="par0195" class="elsevierStylePara elsevierViewall">protein C</p></span><span class="elsevierStyleDefTerm">PT</span><span class="elsevierStyleDefDescription"><p id="par0200" class="elsevierStylePara elsevierViewall">prothrombin time</p></span><span class="elsevierStyleDefTerm">aPTT</span><span class="elsevierStyleDefDescription"><p id="par0205" class="elsevierStylePara elsevierViewall">activated partial thromboplastin</p></span><span class="elsevierStyleDefTerm">PPP</span><span class="elsevierStyleDefDescription"><p id="par0210" class="elsevierStylePara elsevierViewall">poor platelet plasma</p></span><span class="elsevierStyleDefTerm">PS</span><span class="elsevierStyleDefDescription"><p id="par0215" class="elsevierStylePara elsevierViewall">protein S</p></span><span class="elsevierStyleDefTerm">AT</span><span class="elsevierStyleDefDescription"><p id="par0220" class="elsevierStylePara elsevierViewall">antithrombin</p></span><span class="elsevierStyleDefTerm">TG</span><span class="elsevierStyleDefDescription"><p id="par0225" class="elsevierStylePara elsevierViewall">thrombin generation</p></span></span></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Copyright assignment</span><p id="par0230" class="elsevierStylePara elsevierViewall">In consideration of the Fundaci&#243;n Cl&#237;nica M&#233;dica Sur &#40;FCMS&#41; taking action to review and edit my submission&#44; the undersigned authors&#44; jointly and severally&#44; hereby transfer&#44; convey&#44; and assign all right&#44; title&#44; and interest therein&#44; including any and all copyrights in all forms and media now or hereafter known&#44; to the FCMS&#46; The authors retain the nonexclusive right to use all or part of the Article in future works of their own in a noncompeting way&#44; provided proper copyright credit is given to the Foundation&#46; Should the FCMS not publish the aforesaid submission&#44; the FCMS agrees to release its rights therein &#40;Note&#58; material prepared by employees of the federal government in their official duties may not be copyrightable&#41;&#46; No guarantee is made that the Article will be published&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Authorship responsibility</span><p id="par0235" class="elsevierStylePara elsevierViewall">I&#44; the undersigned author&#44; certify that I have participated sufficiently in the intellectual content&#44; the analysis of data&#44; if applicable&#44; and the writing of the Article&#44; to take public responsibility for it&#46; I have reviewed the final version of the Article&#44; believe it represents valid work&#44; and approve it for publication&#46; As an author of this Article&#44; I certify that none of the material in the manuscript has been published previously&#44; is included in another manuscript&#44; or is currently under consideration for publication elsewhere&#46; I also certify that the Article has not been accepted for publication elsewhere&#44; nor have I assigned any right or interest in the Article to any third party&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financial disclosure</span><p id="par0240" class="elsevierStylePara elsevierViewall">I&#44; the undersigned author&#44; certify that I have no commercial associations &#40;e&#46;g&#46;&#44; consultancies&#44; stock ownership&#44; equity interests&#44; patent-licensing arrangements&#41; that might pose a conflict of interest in connection with the submitted article&#46; This work did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Institutional Review Board&#47;Animal Care Committee Approval</span><p id="par0245" class="elsevierStylePara elsevierViewall">I&#44; the undersigned author&#44; certify that my institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Author contributions</span><p id="par0250" class="elsevierStylePara elsevierViewall">Asma labidi&#44; Hela Baccouche&#44; Monia Fekih and Neila BenRomdhane designed the study&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Hela Baccouche carried out biological tests&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Asma Labidi and Hela Baccouche analyzed the data&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Asma labidi wrote the manuscript with the support of Hela Baccouche&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">All authors discussed the results and contributed to the final manuscript&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interest</span><p id="par0280" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Informed consent</span><p id="par0290" class="elsevierStylePara elsevierViewall">All patients gave their informed consent for publication of the case details&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:14 [
        0 => array:3 [
          "identificador" => "xres1233320"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and Objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Materials and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1145652"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patient population and study design"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Blood collection"
            ]
            2 => array:3 [
              "identificador" => "sec0025"
              "titulo" => "Laboratory tests"
              "secciones" => array:4 [
                0 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Conventional laboratory tests"
                ]
                1 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Pro and anticoagulant factors"
                ]
                2 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "Thrombin generation"
                ]
                3 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Hemostatic balance"
                ]
              ]
            ]
            3 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "sec0055"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Conventional laboratory tests"
            ]
            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Procoagulant and anticoagulant factors"
            ]
            2 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Thrombin generation"
            ]
            3 => array:3 [
              "identificador" => "sec0075"
              "titulo" => "Hemostatic balance"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0080"
                  "titulo" => "The ratios of pro- to anticoagulant factors"
                ]
                1 => array:2 [
                  "identificador" => "sec0085"
                  "titulo" => "ETP ratio"
                ]
              ]
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Copyright assignment"
        ]
        7 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Authorship responsibility"
        ]
        8 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Financial disclosure"
        ]
        9 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Institutional Review Board&#47;Animal Care Committee Approval"
        ]
        10 => array:2 [
          "identificador" => "sec0115"
          "titulo" => "Author contributions"
        ]
        11 => array:2 [
          "identificador" => "sec0120"
          "titulo" => "Conflict of interest"
        ]
        12 => array:2 [
          "identificador" => "sec0125"
          "titulo" => "Informed consent"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-02-07"
    "fechaAceptado" => "2018-10-04"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1145652"
          "palabras" => array:5 [
            0 => "Gastrointestinal hemorrhage"
            1 => "Hypercoagulability"
            2 => "Liver"
            3 => "Prothrombin time"
            4 => "Thrombosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">For long&#44; bleeding in cirrhotic patients has been associated with acquired coagulation disorders&#46; The aim of our study was to investigate the impact of acquired coagulation disorders on bleeding risk in cirrhotic patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Blood samples were collected from 51 cirrhotic patients with &#40;H&#43;&#41; or without &#40;H&#8722;&#41; bleeding events and 50 controls matched by age and sex&#46; Thrombin generation was assessed as endogenous thrombin potential &#40;ETP&#41;&#46; Hemostatic balance was assessed by means of ratios of pro- to anticoagulant factors and by ETP ratio with&#47;without protein C &#40;PC&#41; activator &#40;ETP ratio&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bleeding events occurred in 9 patients &#40;17&#46;6&#37;&#41;&#46; Compared with controls&#44; VIII&#47;anticoagulant factors&#44; VII&#47;PC and XII&#47;PC were significantly higher in &#40;H&#43;&#41; patients&#46; No significant difference as regards all ratios across patient groups was detected&#46; ETP ratio was significantly higher in &#40;H&#43;&#41; patients than in controls &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41;&#46; However&#44; there was no significant difference between patient groups as regards ETP ratio&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hemostatic balance is shifted toward a hypercoagulability state even in cirrhotic patients who experienced bleeding&#46; These findings provide evidence against traditional concept of hemostasis-related bleeding tendency in cirrhotic patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 975
            "Ancho" => 2342
            "Tamanyo" => 61728
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparison of ETP ratio between &#40;H&#43;&#41; patients and controls &#40;A&#41;&#44; and between &#40;H&#43;&#41; and &#40;H&#8722;&#41; patients &#40;B&#41;&#46; H&#43;&#58; cirrhotic patients who experienced bleeding&#59; H&#8722;&#58; cirrhotic patients who did not experienced bleeding&#59; ETP&#58; endogenous thrombin potential&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">H&#43;&#58; cirrhotic patients who experienced bleeding&#59; H&#8722;&#58; cirrhotic patients who did not experienced bleeding&#59; PT&#58; prothrombin time&#59; aPTT&#58; activated partial thromboplastin&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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">Parameters&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">H&#43;&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">H&#8722;&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"><span class="elsevierStyleItalic">p</span>-Value&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">Platelet count &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;888<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#44;650&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&#44;317<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#44;483&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">PT &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1&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">aPTT &#40;ratio&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&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">Fibrinogen &#40;g&#47;L&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2106816.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Comparison between patients groups as regards conventional laboratory tests&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">H&#43;&#58; cirrhotic patients who experienced bleeding&#59; H&#8722;&#58; cirrhotic patients who did not experienced bleeding&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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">Parameters&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">H&#43;&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">Controls&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"><span class="elsevierStyleItalic">p</span> value<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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">H&#8722;&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"><span class="elsevierStyleItalic">p</span>-Value<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&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">Factor II &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;46&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;519&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">Factor V &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;6&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;157&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">Factor VII &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>43&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;188&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">Factor XII &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;357&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">Factor VIII &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">166<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>123&#46;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38&#46;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;045&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>96&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;433&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">Protein C &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;146&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">Protein S &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;187&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">Antithrombin &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2106818.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">&#40;H&#43;&#41; group vs&#46; controls&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">&#40;H&#43;&#41; vs&#46; &#40;H&#8722;&#41; group&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparison between patients groups and controls as regards procoagulant and anticoagulant factors&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">PS&#58; protein S&#59; PC&#58; protein C&#59; AT&#58; antithrombin&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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">Parameters&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">H&#43;&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">Controls&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"><span class="elsevierStyleItalic">p</span> value<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&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">H&#8722;&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"><span class="elsevierStyleItalic">p</span>-Value<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&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">II&#47;PS&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;926&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;493&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">II&#47;PC&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;25&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;233&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">II&#47;AT&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;531&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;651&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">V&#47;PS&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;694&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;885&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">V&#47;PC&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;25&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;414&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;756&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">V&#47;AT&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;073&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;128&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">VII&#47;PS&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;437&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;984&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">VII&#47;PC&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;030<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;664&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">VII&#47;AT&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;160&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;261&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">XII&#47;PS&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;910&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;810&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">XII&#47;PC&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;470&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">XII&#47;AT&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;249&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;307&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">VIII&#47;PS&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;506&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">VIII&#47;PC&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;598&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">VIII&#47;AT&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;5&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;922&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2106817.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">&#40;H&#43;&#41; group vs&#46; controls&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">&#40;H&#43;&#41; vs&#46; &#40;H&#8722;&#41; group&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison between patients groups and controls as regards ratios of pro to anticoagulant factors&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "&#91;1&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastroesophageal variceal hemorrhage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;I&#46; Sharara"
                            1 => "D&#46;C&#46; Rockey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra003007"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "345"
                        "paginaInicial" => "669"
                        "paginaFinal" => "681"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11547722"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642009004679"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "&#91;2&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperfibrinolysis resulting from clotting activation in patients with different degrees of cirrhosis&#46; The CALC Group&#46; Coagulation abnormalities in liver cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Violi"
                            1 => "D&#46; Ferro"
                            2 => "S&#46; Basili"
                            3 => "C&#46; Quintarelli"
                            4 => "A&#46; Musca"
                            5 => "C&#46; Cordova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "1993"
                        "volumen" => "17"
                        "paginaInicial" => "78"
                        "paginaFinal" => "83"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "&#91;3&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procoagulant versus anticoagulant factors in cirrhotic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; El Bokl"
                            1 => "A&#46; Shawky"
                            2 => "G&#46;S&#46; Riad"
                            3 => "H&#46;S&#46; Abdel Fattah"
                            4 => "H&#46; Shalaby"
                            5 => "A&#46; Nady"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajg.2014.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arab J Gastroenterol"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "123"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25249231"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "&#91;4&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coagulation abnormalities in patients with chronic liver disease in Pakistan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Siddiqui"
                            1 => "M&#46; Ahmed"
                            2 => "M&#46;H&#46; Ghani"
                            3 => "M&#46;A&#46; Memon"
                            4 => "G&#46; Mustafa"
                            5 => "M&#46;A&#46; Ghori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pak Med Assoc"
                        "fecha" => "2011"
                        "volumen" => "61"
                        "paginaInicial" => "363"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21465974"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "&#91;5&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rebalanced hemostasis in patients with liver disease&#58; evidence and clinical consequences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Lisman"
                            1 => "R&#46;J&#46; Porte"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2010-02-261891"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2010"
                        "volumen" => "116"
                        "paginaInicial" => "878"
                        "paginaFinal" => "885"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20400681"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "&#91;6&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Upper gastrointestinal bleeding in patients with liver cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "O&#46;O&#46; Odelowo"
                            1 => "D&#46;T&#46; Smoot"
                            2 => "K&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Med Assoc"
                        "fecha" => "2002"
                        "volumen" => "94"
                        "paginaInicial" => "712"
                        "paginaFinal" => "715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12152928"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "&#91;7&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Liver biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;C&#46; Rockey"
                            1 => "S&#46;H&#46; Caldwell"
                            2 => "Z&#46;D&#46; Goodman"
                            3 => "R&#46;C&#46; Nelson"
                            4 => "A&#46;D&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.22742"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2009"
                        "volumen" => "49"
                        "paginaInicial" => "1017"
                        "paginaFinal" => "1044"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19243014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "&#91;8&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acquired coagulation disorders&#58; revisited using global coagulation&#47;anticoagulation testing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Tripodi"
                            1 => "V&#46; Chantarangkul"
                            2 => "P&#46;M&#46; Mannucci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2141.2009.07833.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Haematol"
                        "fecha" => "2009"
                        "volumen" => "147"
                        "paginaInicial" => "77"
                        "paginaFinal" => "82"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19659548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "&#91;9&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures&#58; an evidence-based review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;B&#46; Segal"
                            1 => "W&#46;H&#46; Dzik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Transfusion &#40;Paris&#41;"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "1413"
                        "paginaFinal" => "1425"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "&#91;10&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing concepts of cirrhotic coagulopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Tripodi"
                            1 => "M&#46; Primignani"
                            2 => "P&#46;M&#46; Mannucci"
                            3 => "S&#46;H&#46; Caldwell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2016.498"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2017"
                        "volumen" => "112"
                        "paginaInicial" => "274"
                        "paginaFinal" => "281"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27801884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "&#91;11&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delicate balance of bleeding and thrombosis in end-stage liver disease and liver transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;H&#46; Saner"
                            1 => "R&#46;K&#46; Gieseler"
                            2 => "H&#46; Akiz"
                            3 => "A&#46; Canbay"
                            4 => "K&#46; Gorlinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000354400"
                      "Revista" => array:6 [
                        "tituloSerie" => "Digestion"
                        "fecha" => "2013"
                        "volumen" => "88"
                        "paginaInicial" => "135"
                        "paginaFinal" => "144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24008288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "&#91;12&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Review article&#58; thrombocytopenia in chronic liver disease and pharmacologic treatment options"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;G&#46; Giannini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2036.2006.02889.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2006"
                        "volumen" => "23"
                        "paginaInicial" => "1055"
                        "paginaFinal" => "1065"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16611265"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "&#91;13&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;G&#46; Giannini"
                            1 => "A&#46; Greco"
                            2 => "S&#46; Marenco"
                            3 => "E&#46; Andorno"
                            4 => "U&#46; Valente"
                            5 => "V&#46; Savarino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cgh.2010.06.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
                        "fecha" => "2010"
                        "volumen" => "8"
                        "paginaInicial" => "899"
                        "paginaFinal" => "902"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20601131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "&#91;14&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of fibrinogen in trauma-induced coagulopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Fries"
                            1 => "W&#46;Z&#46; Martini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aeq161"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "116"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20627882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "&#91;15&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coagulation studies as a prognostic index in acute liver failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46;W&#46; Dymock"
                            1 => "J&#46;S&#46; Tucker"
                            2 => "I&#46;L&#46; Woolf"
                            3 => "L&#46; Poller"
                            4 => "J&#46;M&#46; Thomson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2141.1975.tb01836.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Haematol"
                        "fecha" => "1975"
                        "volumen" => "29"
                        "paginaInicial" => "385"
                        "paginaFinal" => "395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1201157"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "&#91;16&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Haemostatic balance in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Baccouche"
                            1 => "A&#46; Labidi"
                            2 => "M&#46; Fekih"
                            3 => "S&#46; Mahjoub"
                            4 => "H&#46; Kaabi"
                            5 => "S&#46; Hmida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Blood Coagul Fibrinolysis"
                        "fecha" => "2017"
                        "volumen" => "28"
                        "paginaInicial" => "139"
                        "paginaFinal" => "144"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "&#91;17&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tripodi"
                            1 => "M&#46; Primignani"
                            2 => "V&#46; Chantarangkul"
                            3 => "A&#46; Dell&#8217;Era"
                            4 => "M&#46; Clerici"
                            5 => "R&#46; de Franchis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2009"
                        "volumen" => "137"
                        "paginaInicial" => "2105"
                        "paginaFinal" => "2111"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "&#91;18&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of the imbalance of procoagulant versus anticoagulant factors in cirrhosis by a simple laboratory method"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tripodi"
                            1 => "M&#46; Primignani"
                            2 => "L&#46; Lemma"
                            3 => "V&#46; Chantarangkul"
                            4 => "A&#46; Dell&#8217;Era"
                            5 => "F&#46; Iannuzzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.23653"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2010"
                        "volumen" => "52"
                        "paginaInicial" => "249"
                        "paginaFinal" => "255"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20578143"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "&#91;19&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis&#58; a randomized&#44; controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Bosch"
                            1 => "D&#46; Thabut"
                            2 => "A&#46; Albillos"
                            3 => "N&#46; Carbonell"
                            4 => "J&#46; Spicak"
                            5 => "J&#46; Massard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.22216"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2008"
                        "volumen" => "47"
                        "paginaInicial" => "1604"
                        "paginaFinal" => "1614"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18393319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "&#91;20&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy of a single bolus administration of recombinant factor VIIa in liver transplantation due to chronic liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Planinsic"
                            1 => "J&#46; van der Meer"
                            2 => "G&#46; Testa"
                            3 => "L&#46; Grande"
                            4 => "A&#46; Candela"
                            5 => "R&#46;J&#46; Porte"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lt.20458"
                      "Revista" => array:6 [
                        "tituloSerie" => "Liver Transpl"
                        "fecha" => "2005"
                        "volumen" => "11"
                        "paginaInicial" => "895"
                        "paginaFinal" => "900"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16035081"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "&#91;21&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tripodi"
                            1 => "F&#46; Salerno"
                            2 => "V&#46; Chantarangkul"
                            3 => "M&#46; Clerici"
                            4 => "M&#46; Cazzaniga"
                            5 => "M&#46; Primignani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20569"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "553"
                        "paginaFinal" => "558"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15726661"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "&#91;22&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coagulation abnormalities in the cirrhotic patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Mucino-Bermejo"
                            1 => "R&#46; Carrillo-Esper"
                            2 => "M&#46; Uribe"
                            3 => "N&#46; Mendez-Sanchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Hepatol"
                        "fecha" => "2013"
                        "volumen" => "12"
                        "paginaInicial" => "713"
                        "paginaFinal" => "724"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24018489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "&#91;23&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coagulation disorders and hemostasis in liver disease&#58; pathophysiology and critical assessment of current management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;H&#46; Caldwell"
                            1 => "M&#46; Hoffman"
                            2 => "T&#46; Lisman"
                            3 => "B&#46;G&#46; Macik"
                            4 => "P&#46;G&#46; Northup"
                            5 => "K&#46;R&#46; Reddy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.21303"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2006"
                        "volumen" => "44"
                        "paginaInicial" => "1039"
                        "paginaFinal" => "1046"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17006940"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "&#91;24&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanism of the abnormal vitamin K-dependent gamma-carboxylation process in human hepatocellular carcinomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;G&#46; Huisse"
                            1 => "M&#46; Leclercq"
                            2 => "J&#46; Belghiti"
                            3 => "J&#46;F&#46; Flejou"
                            4 => "J&#46;W&#46; Suttie"
                            5 => "A&#46; Bezeaud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/1097-0142(19940901)74:5<1533::aid-cncr2820740507>3.0.co;2-v"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1994"
                        "volumen" => "74"
                        "paginaInicial" => "1533"
                        "paginaFinal" => "1541"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7520347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "&#91;25&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The coagulopathy of liver disease&#58; does vitamin K help&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;F&#46; Saja"
                            1 => "A&#46;A&#46; Abdo"
                            2 => "F&#46;M&#46; Sanai"
                            3 => "S&#46;A&#46; Shaikh"
                            4 => "A&#46;G&#46; Gader"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MBC.0b013e32835975ed"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Coagul Fibrinolysis"
                        "fecha" => "2013"
                        "volumen" => "24"
                        "paginaInicial" => "10"
                        "paginaFinal" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23080365"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "&#91;26&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Des-gamma-carboxy &#40;abnormal&#41; prothrombin as a serum marker of primary hepatocellular carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;A&#46; Liebman"
                            1 => "B&#46;C&#46; Furie"
                            2 => "M&#46;J&#46; Tong"
                            3 => "R&#46;A&#46; Blanchard"
                            4 => "K&#46;J&#46; Lo"
                            5 => "S&#46;D&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198405313102204"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1984"
                        "volumen" => "310"
                        "paginaInicial" => "1427"
                        "paginaFinal" => "1431"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6201741"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "&#91;27&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differential effects of vitamin K1 on AFP and DCP levels in patients with unresectable HCC and in HCC cell lines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46;I&#46; Carr"
                            1 => "Z&#46; Wang"
                            2 => "M&#46; Wang"
                            3 => "G&#46; Wei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10620-010-1521-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2011"
                        "volumen" => "56"
                        "paginaInicial" => "1876"
                        "paginaFinal" => "1883"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21188521"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "&#91;28&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for hepatocellular carcinoma may impair the performance of biomarkers&#58; a comparison of AFP&#44; DCP&#44; and AFP-L3"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;L&#46; Volk"
                            1 => "J&#46;C&#46; Hernandez"
                            2 => "G&#46;L&#46; Su"
                            3 => "A&#46;S&#46; Lok"
                            4 => "J&#46;A&#46; Marrero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Biomark"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "paginaInicial" => "79"
                        "paginaFinal" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17522429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16652681/0000001800000004/v3_201908230828/S1665268119300717/v3_201908230828/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "78265"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001800000004/v3_201908230828/S1665268119300717/v3_201908230828/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300717?idApp=UINPBA00004N"
]

Article information

ISSN: 16652681
Original language: English

DOI:10.1016/j.aohep.2018.12.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	0	6
2024 October	24	1	25
2024 September	55	14	69
2024 August	33	11	44
2024 July	44	4	48
2024 June	33	2	35
2024 May	48	4	52
2024 April	56	16	72
2024 March	93	13	106
2024 February	74	6	80
2024 January	53	7	60
2023 December	47	10	57
2023 November	65	14	79
2023 October	49	6	55
2023 September	31	2	33
2023 August	21	7	28
2023 July	26	2	28
2023 June	34	1	35
2023 May	60	4	64
2023 April	70	1	71
2023 March	41	7	48
2023 February	26	4	30
2023 January	21	5	26
2022 December	15	4	19
2022 November	12	9	21
2022 October	17	7	24
2022 September	19	10	29
2022 August	18	9	27
2022 July	18	5	23
2022 June	10	8	18
2022 May	14	7	21
2022 April	29	15	44
2022 March	37	12	49
2022 February	40	11	51
2022 January	88	8	96
2021 December	46	13	59
2021 November	54	10	64
2021 October	79	21	100
2021 September	22	13	35
2021 August	37	17	54
2021 July	24	19	43
2021 June	22	8	30
2021 May	40	13	53
2021 April	121	23	144
2021 March	115	10	125
2021 February	62	13	75
2021 January	54	14	68
2020 December	72	20	92
2020 November	61	20	81
2020 October	41	12	53
2020 September	34	11	45
2020 August	35	12	47
2020 July	35	15	50
2020 June	29	16	45
2020 May	32	13	45
2020 April	35	6	41
2020 March	39	28	67
2020 February	29	18	47
2020 January	44	18	62
2019 December	29	10	39
2019 November	24	5	29
2019 October	29	6	35
2019 September	42	8	50
2019 August	78	20	98
2019 July	39	25	64
2019 June	12	21	33
2019 May	7	21	28

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter