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Low Fibrinogen Levels Are Associated with Bleeding After Varices Ligation in Thrombocytopenic Cirrhotic Patients
Edoardo G. Giannini
Corresponding author
egiannini@unige.it

Correspondence and reprint request:
, Elisa Giambruno, Mattteo Brunacci, Maria Corina Plaz Torres, Manuele Furnari, Giorgia Bodini, Patrizia Zentilin, Vincenzo Savarino
Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino - IRCCS per l’Oncologia, Genoa, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Oesophageal varices can be found in approximately 60&#37; of cirrhotic patients&#44; with or without hepatocellular carcinoma&#44; undergoing screening endoscopy&#44; and their prevalence increases with increasing severity of liver disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> When varices at risk of bleeding are identified&#44; patients should undergo prophylaxis with non-selective beta-blockers or endoscopic variceal band ligation &#40;EVBL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although beta-blockers are suggested as first choice for primary prophylaxis of variceal bleeding&#44; also due to additional positive effects exerted by these drugs on other complications of portal hypertension&#44; between 15 and 20&#37; of cirrhotic patients with varices needing prophylaxis either have contraindications to beta-blockers or develop side effects that preclude their use&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Furthermore&#44; the use of beta-blockers has recently been a matter of a heated debate due to the possible deleterious effects on pa- tients&#8217; survival when iterative paracenteses are performed in patients with refractory ascites&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Thus&#44; in everyday clinical practice&#44; prophylactic EVBL is a frequent procedure in a large proportion of cirrhotic patients with at-risk varices&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">Patients with cirrhosis often display various degrees of thrombocytopenia as well as alteration of common coagulation tests&#44; although the relevance of these abnormalities to the actual risk of bleeding following invasive procedures has not been established&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In a post hoc analysis of a study carried out in cirrhotic patients being evaluated for liver transplant we found that increased International Normalised Ratio &#40;INR&#41; values were not associated with an increased risk of bleeding following invasive procedures&#44; while bleeding tended to occur more frequently in patients with severe thrombocytopenia&#59; another recent study found that both conventional and expanded coagulation indices were not predictive of ulcer bleeding after EVBL in patients with cirrhosis of the liver&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Although sophisticated&#44; global haemostasis tests may be able to evaluate more comprehensively the complex coagulation balance of cirrhotic patients&#44; and even assess its modification in response to blood or blood products transfusions&#44; these assays are not commonly available in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Therefore&#44; in this prospective study we sought to assess whether standard coagulation parameters were predictive of bleeding in a series of cirrhotic patients undergoing EVBL&#46; We focussed on thrombocytopenic patients in order to equalise patients for one possible confounding factor&#44; and hypothesised that identification of simple parameters able to stratify patients&#8217; risk of bleeding may guide clinicians decisions in everyday clinical practice&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Material and Methods</span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Patients</span><p id="p0015" class="elsevierStylePara elsevierViewall">This study included 109 consecutive cirrhotic patients with thrombocytopenia &#40;i&#46;e&#46;&#44; platelet count &#60; 150 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L&#41; who were referred to our Endoscopy Unit for performing prophylactic EVBL&#46; Patients were referred due to the finding of at-risk varices&#44; while patients with previous endoscopic treatment of oesophageal varices&#44; acute variceal bleeding&#44; and infection were not included&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Methods</span><p id="p0020" class="elsevierStylePara elsevierViewall">EVBL was performed in all patients for primary prophylaxis of bleeding&#44; and in 41 patients &#40;37&#46;6&#37;&#41; EVBL was selected due to beta-blocker intolerance or patients preference to EVBL&#46; The endoscope used was an adult gastroscope type Olympus GIF 165 &#40;Olympus Medical Systems&#44; Hamburg&#44; Germany&#41;&#46; EVBL was carried out by an experienced endoscopist using the same procedure for each patient&#46; The elastic bands &#40;median 6&#44; range 5-7&#41; were placed on varices with the same device &#40;Speedband Superview Super 7&#8482; Multiple Band Ligator&#44; Boston Scientific Corporation&#44; Marlborough&#44; MA&#44; USA&#41; in an ascending way through the oesophagus&#46; Food intake was allowed 24 h following the endoscopic procedure&#44; and pantoprazole 40 mg bid was administrated for at least 3 weeks in all patients&#46; After EVBL&#44; patients were followed and regularly monitored at our outpatients for up to 3 weeks&#44; and emergency endoscopies were carried out at our Endoscopy Unit&#46; Post-EVBL bleeding was defined as any clinically significant &#40;at least a 2 g drop in haemoglobin&#44; or any drop accompanied by systemic signs&#41; episode of haematemesis&#44; melena&#44; or both and was confirmed by endoscopic evaluation&#46; Blood samples for complete haemogram&#44; biochemical tests and coagulation parameters were obtained on the same morning of the EVBL procedure&#46; The Child-Pugh score and the Model for End-stage Liver Disease score were used to assess severity of liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Statistical analysis</span><p id="p0025" class="elsevierStylePara elsevierViewall">Continuous variables are shown as median and range and were compared using Mann-Whitney U-test&#44; while categorical variables are shown as absolute count and percentage and were compared using Fisher&#8217;s exact test&#46; Receiver Operating Characteristic &#40;ROC&#41; curve was used to identify the fibrinogen level with the highest accuracy for identifying patients who bled&#44; and sensitivity&#44; specificity&#44; positive and negative predictive values&#44; and positive and negative likelihood ratios for this cut-of were assessed&#46; All analyses were carried out using MedCalc version 8&#46;0&#46;1&#46;0 &#40;MedCalc Software BVBA&#44; Ostend&#44; Belgium&#41;&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Ethics</span><p id="p0030" class="elsevierStylePara elsevierViewall">The study was carried according to the standards of Helsinki declaration and was approved by the local review board&#46; Informed consent was waived as all the study procedures were carried out as standard of care of clinical practice&#46;</p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Results</span><p id="p0035" class="elsevierStylePara elsevierViewall">The main demographic&#44; biochemical&#44; and clinical characteristics of the 109 patients who made up the study population are shown in <a class="elsevierStyleCrossRef" href="#t0005">table 1</a>&#46; Ascites and encephalopathy were present in 54 &#40;49&#46;5&#37;&#41; and 28 &#40;25&#46;6&#37;&#41; patients&#44; respectively&#46; Twenty-four patients had hepatocellular carcinoma &#40;22&#46;0&#37;&#41; and 4 patients had portal vein thrombosis &#40;3&#46;7&#37;&#41;&#46; Aetiology of liver disease was due to chronic infection with hepatitis virus in the majority of patients &#40;n &#61; 74&#44; 68&#46;0&#37;&#41;&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t0010">Table 2</a> shows the patients haematological and coagulation parameters&#46; Twenty-nine patients &#40;26&#46;6&#37;&#41; had an INR &#62; 1&#46;5&#44; and median platelet count was in the severe thrombocytopenia range &#40;58 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L&#59; range&#44; 14-148 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47; L&#41;&#44; with 31 patients &#40;28&#46;4&#37;&#41; having a platelet count &#60; 50 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0045" class="elsevierStylePara elsevierViewall">Before EVBL 22 patients &#40;20&#46;2&#37;&#41;&#44; all with platelet count &#60; 50 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L&#44; received prophylactic platelet transfusions&#46; Bleeding occurred in 6 patients &#40;5&#46;5&#37;&#41; a median of 12 days &#40;range&#44; 7-18 days&#41; after EVBL&#44; and post-EVBL bleeding was successfully managed by pharmacologic and endoscopic treatment in all patients&#46; No patients received plasma or platelet transfusions&#44; or coagulation factors transfusions at the time of bleeding&#44; and no deaths were recorded due to bleeding&#46; <a class="elsevierStyleCrossRef" href="#t0015">Table 3</a> reports the biochemical&#44; haematological&#44; and coagulation parameters of patients subdivided according to the occurrence of post-EVBL bleeding&#46; Eleven patients &#40;10&#46;1&#37;&#41; had a creatinine level above the upper limit of normal &#40;i&#46;e&#46;&#44; 1&#46;3 mg&#47;dL&#41; and none of them bled&#46; Moreover&#44; among the 22 patients with hepatocellular carcinoma only one bled &#40;4&#46;5&#37;&#41; and none of the 4 patients with portal vein thrombosis bled&#46; Patients who bled had significantly lower fibrinogen levels &#91;146 mg&#47;dL &#40;98 - 262&#41; <span class="elsevierStyleItalic">vs&#46;</span> 230 mg&#47;dL &#40;104 - 638&#41;&#44; P &#61; 0&#46;009&#44; <a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>&#93;&#44; while there was no significant difference in median platelet counts &#91;58 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L &#40;31 - 105&#41; <span class="elsevierStyleItalic">vs&#46;</span> 54 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L &#40;14 - 148&#41;&#44; P &#61; 0&#46;413&#93; and INR values &#91;1&#46;41 &#40;1&#46;11 - 1&#46;79&#41; <span class="elsevierStyleItalic">vs&#46;</span> 1&#46;36 &#40;0&#46;98 -2&#46;01&#41;&#44; P &#61; 0&#46;198&#93; as well as in the proportion of patients with either an INR &#62; 1&#46;5 &#91;2 &#40;33&#46;3&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> 27 &#40;26&#46;2&#37;&#41;&#44; P &#61; 0&#46;656&#93; or a platelet count &#60; 50 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L &#91;2 &#40;33&#46;3&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> 29 &#40;28&#46;2&#37;&#41;&#44; P &#61; 1&#46;0&#93; between patients who bled and those who did not bleed&#46; No association was found either between haematocrit&#44; haemoglobin levels&#44; or white blood cells count and bleeding&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0050" class="elsevierStylePara elsevierViewall">ROC curve was used to identify the fibrinogen level with the highest accuracy for predicting post-EVBL bleeding &#40;<a class="elsevierStyleCrossRef" href="#f0010">Figure 2</a>&#41;&#46; We found that a fibrinogen level cut-off of 179 mg&#47;dL had an 83&#46;3&#37; sensitivity&#44; 73&#46;0 specificity&#44; 15&#46;6&#37; positive predictive value&#44; 98&#46;6&#37; negative predictive value&#44; and 0&#46;820 accuracy &#40;95&#37; confidence interval &#61; 0&#46;733 to 0&#46;888&#41; for predicting bleeding&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Discussion</span><p id="p0055" class="elsevierStylePara elsevierViewall">In patients with cirrhosis&#44; primary prophylaxis of variceal bleeding often relies on EVBL due to the relatively frequent intolerance to beta-blockers and to the lack of an adequate means to evaluate effectiveness of drug prophylaxis when hepatic venous gradient measurement is not available&#46; Bleeding after EVBL reportedly occurs in 1&#46;2 -7&#46;3&#37; of patients undergoing this procedure&#44; and the predictive factors for bleeding have been investigated in 2 previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In particular&#44; Vanbiervliet&#44; et al&#46; reported that a low prothrombin activity was an independent predictor of post-EVBL bleeding in a case-control study&#44; while Vieira da Rocha&#44; et al&#46; found that neither conventional nor expanded coagulation tests were predictive of bleeding after EVBL&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> However&#44; the former study was not focused on coagulation parameters&#44; included patients with prevalently alcoholic cirrhosis &#40;71&#37;&#41; and a history of previous variceal bleeding in 59&#37; of cases&#44; and reported a mortality due to post-EVBL as high as 52&#37;&#44; while the latter study purposely assessed coagulation parameters as possible predictors of bleeding&#44; but in doing so categorised patients according to pre-defined INR and platelet count cut-offs&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="p0060" class="elsevierStylePara elsevierViewall">In this study we aimed at evaluating whether platelet counts or conventional coagulation parameters were predictors of bleeding following EVBL&#46; We included only patients with thrombocytopenia &#40;i&#46;e&#46;&#44; platelet count &#60; 150 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L&#41; in order to evaluate patients where an hypothetical risk factor for bleeding was present and to exclude a possible bias related to a skewed distribution for this characteristic&#46; Moreover&#44; we decided to avoid categorising patients a priori according to pre-defined coagulation and platelet count cut-offs&#44; due to the absence of a clear evidence in the literature suggesting a definite threshold for increased risk of bleeding regarding these parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Lastly&#44; we also included patients with renal failure and hepatocellular carcinoma as we deemed that the results of a study carried out in this population might more closely reflect everyday clinical practice&#46; Overall&#44; we found that both INR values and platelet counts were not associated with bleeding&#44; and that this absence of association was confirmed also when patients were categorised according to hypothetical risk factors for bleeding such as an INR &#62; 1&#46;5 or a platelet count &#60; 50 &#215; 10<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#47;L&#46; Although some patients underwent platelet transfusion before EVBL&#44; it is unlikely that this might have influenced bleeding rate as in these patients single platelet transfusion reportedly have minimal efficacy in increasing platelet counts&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> As previous reports suggested that decreased haematocrit may increase the risk of bleeding in cirrhotic patients due to the rheological effect of erythrocytes on platelet adhesion&#44; we also evaluated whether haematocrit and haemoglobin levels were related to bleeding&#44; and found no association between these parameters and post-EVBL bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Noteworthy&#44; we also observed no association between bleeding and creatinine levels or the presence of renal failure&#44; although we have to emphasize that all the patients included in this study were in stable conditions&#46; The main result of our study was that patients who had post-EVLB bleeding had significantly lower fibrinogen levels&#44; and that a fibrinogen level of 179 mg&#47;dL or less had a negative predictive value for bleeding of 98&#46;6&#37;&#46; As the negative predictive value of a variable depends on the disease prevalence&#44; we also calculated that the negative predictive value of the identified fibrinogen cut-off with an incidence of bleeding ranging from 1&#46;2 to 7&#46;3&#37; -as reported in the literature- ranged between 99&#46;7 and 98&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Thus&#44; although the positive predictive value was low&#44; in clinical practice the use of fibrinogen with this cut-off may be able to identify a population of cirrhotic patients where post-EVBL bleeding is very unlikely&#44; and therefore shifting the attention of the clinician on the follow-up of patients with a fibrinogen level below this cut-off&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">As far as the possible role of fibrinogen on the risk of bleeding in patients with cirrhosis in concerned&#44; it is well known that these patients may display abnormal fibrinogen&#44; and some studies have advocated the presence of hyperfibrinolysis as one of the possible mechanisms for increased risk of bleeding in cirrhotic patients&#44; identifying a correlation between decreased fibrinogen levels and increased bleeding time&#44; despite there is still debate on the presence and role of this laboratory characteristic&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> As the role of fibrinogen is to facilitate platelet aggregation by binding glycoprotein IIb&#47;IIIa&#44; and this effects mainly depends upon fibrinogen concentration&#44; the inclusion in our study of patients with thrombocytopenia might have equalised the study population for one possible confounding factor&#44; thus emphasizing the role of fibrinogen&#44; as decreased fibrinogen levels might further impair platelet-to-platelet bridge formation ad increase the likelihood of bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="p0070" class="elsevierStylePara elsevierViewall">One of the possible drawbacks of this study is that we recorded a small number of events&#44; and this finding may have relevance for the predictive values of the identified fibrinogen cut-off&#46; However&#44; we also calculated the negative predictive values of the fibrinogen cut-off identified in this study using the bleeding incidence identified in previous studies&#44; and we found that the predictive ability of the cut-off was not affected&#46; Moreover&#44; we must emphasize that the fibrinogen cut-off identified in our study &#40;i&#46;e&#46;&#44; 179 mg&#47;dL&#41; is higher than the threshold suggested for prophylactic fibrinogen replacement in patients undergoing invasive procedures &#40;i&#46;e&#46;&#44; 120-150 mg&#47;dL&#41;&#44; although we also have to take into account that in our study we did not push the envelope so far as to suggest that patients with a fibrinogen level below 179 mg&#47;dL must receive some form of pre-procedure prophylaxis&#44; and that the fibrinogen cut-offs suggested in the literature are mainly based on experts&#8217; opinion&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> All in all&#44; we found that use of this fibrinogen cut-off allowed to predict a moderate decrease in the likelihood of bleeding&#44; although we feel that due to the small number of patients included in our study these results need to be confirmed in larger cohort of patients&#46; Lastly&#44; it might be that other bio-markers or more sophisticated tests may be able to better predict the risk of bleeding in these patients although&#44; as far as we know&#44; the only study that used both expanded coagulation tests and thromboelastography reported negative results&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="p0075" class="elsevierStylePara elsevierViewall">In conclusion&#44; in this study we identified low fibrinogen levels as the coagulation parameter associated with an increased risk of bleeding following prophylactic EVBL in cirrhotic patients&#46; Use of this simple and readily available parameter may help stratify patients&#8217; risk in clinical practice&#44; although these preliminary results need to be confirmed in larger series&#46;</p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Abbreviations</span><p id="p0080" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ETOH&#58;</span> alcohol&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">EVBL&#58;</span> endoscopic variceal band ligation&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HBV&#58;</span> hepatitis B virus&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HCV&#58;</span> Hepatitis C virus&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">INR&#58;</span> International Normalised Ratio&#46;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MELD&#58;</span> Model for End-stage Live Disease&#46;</p></li><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NASH&#58;</span> Nonalcoholic Steatohepatitis&#46;</p></li><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PBC&#58;</span> Primary Biliary Cholangitis&#46;</p></li><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PSC&#58;</span> Primary Sclerosing Cholangitis&#46;</p></li></ul></p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Declaration of Interest</span><p id="p0130" class="elsevierStylePara elsevierViewall">The authors report no conflicts of interest&#46; The authors alone are responsible for the content and writing of the paper&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Declaration of Funding Source</span><p id="p0135" class="elsevierStylePara elsevierViewall">This study was supported by a grant &#8220;Progetto di ricerca di Ateneo 2014&#8221; dell&#8217;Universit&#224; degli Studi di Genova&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Authorship Statement</span><p id="p0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0050"><span class="elsevierStyleLabel">&#8226;</span><p id="p0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Guarantor of article&#58;</span> Edoardo G&#46; Giannini&#46;</p></li><li class="elsevierStyleListItem" id="u0055"><span class="elsevierStyleLabel">&#8226;</span><p id="p0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Specific author contributions&#58;</span> Edoardo G&#46; Giannini&#44; Elisa Giambruno&#44; Matteo Brunacci&#44; Maria Corina Plaz Torres&#44; Manuele Furnari&#44; and Giorgia Bodini performed the research&#44; Edoardo G&#46; Giannini&#44; Elisa Giambruno&#44; Matteo Brunacci&#44; and Maria Corina Plaz Torres collected and analysed the data&#44; Edoardo G&#46; Giannini designed the research study and wrote the paper&#44; and Patrizia Zentilin&#44; Manuele Furnari&#44; Giorgia Bodini&#44; and Vincenzo Savarino contributed to the design of the study&#46;</p></li></ul></p><p id="p0155" class="elsevierStylePara elsevierViewall">All authors approved the final version of the article&#44; including the authorship list&#46;</p></span></span>"
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    "fechaRecibido" => "2017-10-12"
    "fechaAceptado" => "2017-12-05"
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            0 => "Platelets"
            1 => "Thrombocytopenia"
            2 => "Oesophageal varices"
            3 => "Portal hypertension"
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        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction and Aim&#46;</span> EVBL is a procedure frequently performed in cirrhotic patients for primary prophylaxis of bleeding&#46; Patients with cirrhosis display various degrees of alteration of common coagulation parameters&#44; and it is not known whether these alterations may predict post-EVBL bleeding&#46; To evaluate factors predictive of post-endoscopic variceal band ligation &#40;EVBL&#41; bleeding in cirrhotic patients with thrombocytopenia&#46;</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods&#46;</span> We included 109 patients with cirrhosis undergoing EVBL for primary prophylaxis of variceal bleeding&#46; Common coagulation parameters &#40;INR&#44; fibrinogen levels&#41; and complete haemogram were obtained in all patients and evaluated subdividing patients in bleeders and non bleeders following EVBL&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#46;</span> The incidence of post-EVBL bleeding was 5&#46;5&#37; &#40;6 patients&#41;&#46; INR and platelet counts&#44; considered as continuous or dichotomous variables according to common cut-offs &#40;i&#46;e&#46;&#44; INR &#62; 1&#46;5&#44; platelet count &#60; 50 &#215; 10<span class="elsevierStyleSup">9</span>&#47;L&#41; were not predictors of post-EVBL bleeding&#46; Patients who bled had significantly lower fibrinogen levels &#91;146 mg&#47;dL &#40;98 - 262&#41; <span class="elsevierStyleItalic">vs&#46;</span> 230 mg&#47;dL &#40;104 - 638&#41;&#44; P &#61; 0&#46;009&#93;&#44; and no other biochemical or clinical predictors of bleeding were identified&#46; A fibrinogen cut-off of 179 mg&#47;dL had 98&#46;6&#37; negative predictive value for bleeding&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusion&#46;</span> Low fibrinogen levels are associated with an increased risk of bleeding following prophylactic EVBL in cirrhotic patients&#44; and might be used to stratify patients&#8217; risk&#46; However&#44; due to their preliminary nature&#44; these findings need to be confirmed in larger populations&#46;</p></span>"
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Fibrinogen levels &#40;box-and-whisker plot&#41; of the study population subdivided according to occurrence of post-variceal banding bleeding&#46;</p>"
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Receiver Operating Characteristic curve of fibrinogen levels according to bleeding&#46; Dot indicates the fibrinogen level with the highest accuracy &#40;i&#46;e&#46;&#44; 179 mg&#47;dL&#41;&#46;</p>"
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          "leyenda" => "<p id="np0005" class="elsevierStyleSimplePara elsevierViewall">MELD&#58; Model for End-stage Live Disease&#46; HCV&#58; hepatitis C virus&#46; HBV&#58; hepatitis B virus&#46; ETOH&#58; alcohol&#46; NASH&#58; nonalcoholic steatohepatitis&#46; PSC&#58; primary sclerosing cholangitis&#46; PBC&#58; primary biliary cholangitis&#46;</p>"
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;65&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Years&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;28 - 85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top">Aetiology of liver disease</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HCV&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;62&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBV&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ETOH&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NASH&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSC&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PBC&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Albumin&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">g&#47;dL&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5 &#40;2&#46;1 - 4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilirubin&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mg&#47;dL&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;29 &#40;0&#46;37 - 9&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Creatinine&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mg&#47;dL&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;90 &#40;0&#46;50 - 2&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD score&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;7 - 21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Child-Pugh&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">class&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;52&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;37&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2033452.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Main demographic&#44; biochemical&#44; and clinical characteristics of the study population&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="np0010" class="elsevierStyleSimplePara elsevierViewall">INR&#58; International Normalised Ratio&#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">Parameter&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unit&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haemoglobin&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">g&#47;dL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9 &#40;7&#46;0 - 15&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haematocrit&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;9 &#40;21&#46;0 - 45&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">White blood cells&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n &#215; 109&#47;L&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;23 &#40;1&#46;00 - 8&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Platelets&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n &#215; 109&#47;L&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;14 - 148&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">INR&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;38 &#40;0&#46;98 - 2&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrinogen&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mg&#47;dL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">221 &#40;98 - 638&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2033450.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Main haematological and coagulation parameters of the study population&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "t0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="np0015" class="elsevierStyleSimplePara elsevierViewall">INR&#58; International Normalised Ratio&#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">Parameter&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unit&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non bleeders&#40;n&#61;103&#41;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bleeders &#40;n &#61; 6&#41;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Albumin&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">g&#47;dL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6 &#40;2&#46;2 - 4&#46;6&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3 &#40;2&#46;1 - 3&#46;8&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilirubin&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mg&#47;dL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;36 &#40;0&#46;27 - 9&#46;12&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;09 &#40;0&#46;84 - 4&#46;22&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Creatinine&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mg&#47;dL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;90 &#40;0&#46;50 - 2&#46;34&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;90 &#40;0&#46;60 - 1&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;639&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD score&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;7 - 21&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;8 - 19&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="top">Child-Pugh class</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;54&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B and C&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;45&#46;6&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#46;3&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haemoglobin&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">g&#47;dL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;9 &#40;7&#46;0 - 15&#46;0&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;0 &#40;8&#46;1 - 14&#46;1&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;402&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haematocrit&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3 &#40;21&#46;0 - 45&#46;0&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;1 &#40;24&#46;3 - 42&#46;3&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;567&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">White blood cells&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n &#215; 109&#47;L&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;21 &#40;1&#46;00 - 8&#46;50&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;70 &#40;1&#46;35 - 8&#46;86&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Platelets&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n &#215; 109&#47;L&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;14 - 148&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;31 - 105&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;413&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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