Share
array:24 [ "pii" => "S2341192923000264" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.10.006" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1408" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:68-76" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935621003042" "issn" => "00349356" "doi" => "10.1016/j.redar.2021.10.007" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1408" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2023;70:68-76" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Pruebas de coagulación preoperatorias en pacientes pediátricos: relevancia clínica y consecuencias hemorrágicas de los resultados anómalos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "68" "paginaFinal" => "76" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Preoperative coagulation screening tests in pediatric patients: Clinical relevance and hemorrhagic outcomes of abnormal results" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1990 "Ancho" => 2933 "Tamanyo" => 358815 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo de la población de estudio.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">APTT: tiempo de tromboplastina parcial activado; PT: tiempo de protrombina.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Zamudio Penko, D. Cancho García, A. Bartolomé Ruibal, N. Gijón Herreros, P. Redondo Martínez, L. Gisbert de la Cuadra, S. García del Valle" "autores" => array:7 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Zamudio Penko" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Cancho García" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Bartolomé Ruibal" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Gijón Herreros" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Redondo Martínez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Gisbert de la Cuadra" ] 6 => array:2 [ "nombre" => "S." "apellidos" => "García del Valle" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192923000264" "doi" => "10.1016/j.redare.2021.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000264?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621003042?idApp=UINPBA00004N" "url" => "/00349356/0000007000000002/v1_202301310659/S0034935621003042/v1_202301310659/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192923000276" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.08.001" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1409" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:77-82" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Simulation in healthcare during COVID-19: An experience with residents in Anaesthesiology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "77" "paginaFinal" => "82" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Simulación sanitaria durante la COVID-19: una experiencia con los residentes de Anestesiología" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Laurens, J. Bañeras, A. Biarnés, S. Nuñez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Laurens" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Bañeras" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Biarnés" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Nuñez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935621003054" "doi" => "10.1016/j.redar.2021.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621003054?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000276?idApp=UINPBA00004N" "url" => "/23411929/0000007000000002/v1_202303141745/S2341192923000276/v1_202303141745/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192923000288" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.11.007" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1410" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:65-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Should we consider the indication of placebo in clinical practice?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "67" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Se debería plantear la indicación del placebo en la práctica clínica?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Dalmau Llitjos" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Dalmau Llitjos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935621003066" "doi" => "10.1016/j.redar.2021.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621003066?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000288?idApp=UINPBA00004N" "url" => "/23411929/0000007000000002/v1_202303141745/S2341192923000288/v1_202303141745/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Preoperative coagulation screening tests in pediatric patients: Clinical relevance and hemorrhagic outcomes of abnormal results" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "68" "paginaFinal" => "76" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Zamudio Penko, D. Cancho García, A. Bartolomé Ruibal, N. Gijón Herreros, P. Redondo Martínez, L. Gisbert de la Cuadra, S. García del Valle" "autores" => array:7 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Zamudio Penko" "email" => array:1 [ 0 => "dianaz_18@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Cancho García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Bartolomé Ruibal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "N." "apellidos" => "Gijón Herreros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "Redondo Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "Gisbert de la Cuadra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "S." "apellidos" => "García del Valle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anestesiología, Hospital Universitario HM de Montepríncipe, Madrid. Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pruebas de coagulación preoperatorias en pacientes pediátricos: relevancia clínica y consecuencias hemorrágicas de los resultados anómalos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1990 "Ancho" => 2933 "Tamanyo" => 354118 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0200" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of the study population.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">APTT: activated partial throboplastin timme; PT: prothrombin time.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">An undetected haemostatic disorder can lead to excessive bleeding during and/or after surgery. Preoperative bleeding evaluation tests continue to be commonly used in clinical practice as an attempt to identify patients with bleeding disorders and thereby introduce targeted interventions to reduce the risk of bleeding and associated complications. Prothrombin time (PT) and activated partial thromboplastin time (APTT) are among the most commonly requested coagulation tests. PT measures the entire extrinsic pathway of the procoagulant cascade (factor VII and tissue factor), while APTT is used to assess the intrinsic pathway including factors VIII, IX, XI, XII, prekallikrein, and high molecular weight quininogen. Both tests also measure the final common pathway (fibrinogen and factors II, V, and X)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> and guidelines<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> advise against indiscriminate coagulation testing and recommend selective testing, based on a thorough clinical evaluation, including bleeding history and physical examination. In patients without a history indicative of a bleeding disorder, such tests are generally not necessary. Despite recommendations, many clinicians continue to rely on routine preoperative coagulation testing, particularly in children, whose bleeding history may be limited by little exposure to haemostatic problems compared to adults<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate the preoperative management of unexpected prolongation of APTT and/ or PT in children undergoing elective surgery, as well as the perioperative risk of haemorrhage.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a retrospective cohort study conducted at the Hospital Universitario Fundación Alcorcón in Madrid, Spain, a general hospital where approximately 300 elective paediatric surgeries are performed per year, excluding neurosurgery and cardiothoracic surgery, in children over two years of age. The study was approved by the Clinical Research Ethics Committee of the Hospital Universitario Fundación Alcorcón (number 20/140), waiving the requirement for written informed consent on 18 September 2020.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0025" class="elsevierStylePara elsevierViewall">We included all children between the ages of two and 17 years, with prolonged APTT and/or PT on routine coagulation tests and prior to elective surgery, who attended preoperative anaesthesia consultation between January 2013 and December 2018. Results were regarded as prolonged when they were above our laboratory’s normal reference range: between 25 and 35<span class="elsevierStyleHsp" style=""></span>s for APTT, and 9−13<span class="elsevierStyleHsp" style=""></span>s for PT. Patients were excluded if they lacked a coagulation evaluation test, had a pre-existing coagulation disorder, or were receiving anticoagulation therapy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Children were divided between those referred to a haematologist prior to surgery, and those scheduled for surgery without further testing.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data collection</span><p id="par0035" class="elsevierStylePara elsevierViewall">The data recorded included age at the time of consultation with Anaesthesia, sex, <span class="elsevierStyleItalic">American Society of Anesthesiology</span> physical status classification, type of procedure, risk of surgical bleeding based on the severity of the procedure and the opinion of our hospital's transfusion committee, presence of a positive personal and/or family history of bleeding, medication use, and co-morbidities. History of bleeding was assessed at the discretion of the anaesthesiologist in charge of the preoperative assessment and standard questionnaires were not used.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Baseline APTT, PT, and haemoglobin values were also noted, as well as the second determination of APTT and/ or PT levels (if the coagulation test was repeated).</p><p id="par0045" class="elsevierStylePara elsevierViewall">In case of referral to haematology, the diagnosis, perioperative haemostatic recommendations, and time elapsed between the first pre-anaesthesia assessment, haematology consultation, and the anaesthesia follow-up consultation were also recorded.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Primary outcome measures</span><p id="par0050" class="elsevierStylePara elsevierViewall">The primary outcome was to assess haemorrhagic complications, which included excessive intraoperative bleeding, extensive postoperative anaemia, intraoperative and postoperative blood transfusion requirements, as well as bleeding requiring urgent reintervention. Excessive intraoperative bleeding was defined as unplanned blood loss greater than 5% of the estimated blood volume in low-risk surgeries, 15% in intermediate-risk surgeries, and 30% in high-risk surgeries, as reported by surgeons or anaesthesiologists. Excessive postoperative anaemia was defined as an unusual decrease in haemoglobin count for the type of surgery, based on the lowest postoperative haemoglobin concentration during the hospital stay. It was deemed unusual when the haemoglobin decrease was greater than 6<span class="elsevierStyleHsp" style=""></span>g/dL in high-risk surgeries, 4<span class="elsevierStyleHsp" style=""></span>g/dL in intermediate-risk surgeries, and 2<span class="elsevierStyleHsp" style=""></span>g/dL in low-risk surgeries.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Secondary outcome measures</span><p id="par0055" class="elsevierStylePara elsevierViewall">Secondary outcomes included the delay of preoperative anaesthesia assessment and additional healthcare costs in those patients who required additional tests. Delay was defined as the time between the first and follow-up consultation with Anaesthesia. Cost was determined on the basis of the price of the haematology consultation, the anaesthesia follow-up consultation, and the additional testing, and calculated on an individual basis per patient.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data source</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patient, procedure, and preoperative management data were obtained from the patient's digital medical record. Those with prolonged APTT and/or PT who attended the anaesthesia consultation were selected using the hospital database. An estimate of the cost of laboratory work-up was obtained from the Clinical Analysis Department. Consultation costs were provided by the Analytical Accounting Department. Prices for haematology and anaesthesia follow-up consultations were €122.11 and €35.82, respectively.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Study size</span><p id="par0065" class="elsevierStylePara elsevierViewall">All patients who attended a preoperative anaesthesia appointment between January 2013 and December 2018 were considered, with no prior power analysis performed.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Patient demographics, preoperative characteristics, and surgery data were compared between groups using <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span>, Fisher’s <span class="elsevierStyleItalic">F</span>, Mann Whitney <span class="elsevierStyleItalic">U</span>, and <span class="elsevierStyleItalic">t</span>-tests as appropriate. A bilateral p-value of less than 0.05 was regarded as statistically significant. Categorical variables are presented as number and percentage, and continuous variables are expressed as means with SD or as medians with interquartile ranges (IQR). The odds ratio (OR) was calculated to gauge the association between positive bleeding history and significant haemostatic disorders.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 1835 children with hemorrhagic evaluation tests were studied (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Of them, 102 had unexpected prolonged APTT and/ or PT (5.6%, 95% CI 4.5–6.6).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The anesthesiologist in charge of the preoperative evaluation repeated the test in six patients (5.9%), but in no case was normalization of APTT or PT observed. Forty-six patients (45.1%, 95% CI 35.4–55) were referred to the Haematology Department, and 56 (54.9%, 95% CI 45.2–64.5) were not. Demographic data and clinical characteristics were similar between both groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Most children had an <span class="elsevierStyleItalic">American Society of Anesthesiologists</span> (ASA) score of I or II, and were scheduled for surgeries with a low risk of bleeding: in 75% of cases, adenoidectomy and/ or tonsillectomy. A positive personal or family history of bleeding was noted in 11 patients (10.8%), 10 of whom were referred to the specialist in haemostasis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In terms of abnoral test results, overall, the most common abnormality was isolated prolonged APTT (66.7%; 95% CI, 57.5–75.8) in both groups. In cases of mild prolongations, of between 35 and 40<span class="elsevierStyleHsp" style=""></span>s, the probability was that the children were not referred to the haematologist (74.5%); of those with APTT greater than 40<span class="elsevierStyleHsp" style=""></span>s, only two cases were not referred, and the rest (15) were re-evaluated. None of the children had an APTT exceeding 50<span class="elsevierStyleHsp" style=""></span>s. Isolated PT prolongation was the second most frequent test abnormality (17.6%; 95% CI, 10.2–25). Similar to isolated APTT prolongations, in many cases, the prolongations were mild (between 13 and 15<span class="elsevierStyleHsp" style=""></span>s) and the children were not referred to a haematologist (78%). When both parameters were abnormal, most patients were referred to the Haematology Department (88%).</p><p id="par0090" class="elsevierStylePara elsevierViewall">The mean APTT value was slightly higher in the patients who were referred (mean 39.9, 95% CI 39.1–40.7) versus those who were not referred to the Haemostasis Unit (mean 37.1, 95% CI 36.5–37.6; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001). Similarly, the mean PT value was also somewhat higher in referred patients (mean 14, 95% CI 13.6–14.4) compared to non-referred patients (mean 13.5, 95% CI 13.3–13.7; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.031).</p><p id="par0095" class="elsevierStylePara elsevierViewall">Forty-five patients were evaluated by a haematologist prior to surgery. The mean time between the first anesthesia consultation and the consultation with the haematologist was 29 days (ICR 25.5–41.5). Complementary laboratory tests were performed in 42 of these subjects (93%, 95% CI 86–100.6), at the discretion of the haematologist in charge. The diagnoses in this group of patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. The main overall cause of unforeseen prolonged APTT and/ or PT was coagulation factor deficiencies (31.1%, 95% CI 17.6–44.6), most frequently FXII.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Perioperative prophylactic treatment was recommended by the haematologist in seven children, five of whom due to factor deficiencies and two due to confirmed or suspected von Willebrand disease (vWD). In the remaining 38 (84%), no changes in management were advised. Although all factor deficiencies were mild and above haemostatic levels, recommendations were determined by type of surgery (adenotonsillectomy) in two patients, given that the haematologist perceived an increased risk of surgical bleeding and hemorrhagic symptoms in three of them. One child was diagnosed with type I vWD and desmopressin was recommended. In addition, another had bleeding symptoms and von Willebrand factor (vWF) levels slightly above the lower reference limit, so vWD was suspected and tranexamic acid administration was advised.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the 10 patients with a positive personal and/ or family history of bleeding referred to the haematologist, six had a significant bleeding disorder, i.e., requiring prophylactic treatment. We observed a strong association between positive bleeding history and significant bleeding disorders, with an OR of 51 (95% CI 4.8–538.5, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0011). Subjects requiring prophylaxis had mild to moderate APTT (mean 40.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.43) and/ or PT (mean 14.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.2) prolongations. These prolongations were similar to those found in non-significant disorders (mean APTT 39.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3 and mean PT 13.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.75) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Primary outcome</span><p id="par0110" class="elsevierStylePara elsevierViewall">Overall, 87 children with prolonged APTT and/or PT underwent elective surgery. Haemorrhagic complications developed in three cases. In one of them, the patient required urgent reoperation days after adenoidectomy; the child had been referred to haematology prior to surgery, and a mild FIX deficiency was diagnosed without the need for perioperative prophylaxis. The other two patients underwent surgery without the need for additional tests. In one case, excessive intraoperative bleeding was observed during adenoidectomy. The patient was therefore referred to Haematology following surgery, and a mild FIX deficiency was also observed. In the other case, excessive postoperative anemia was detected requiring blood transfusions subsequent to surgery for scoliosis. No statistically significant differences were found between those patients who had been referred (3%, 95% CI −2.8–8.9) and those who had not been referred to Haematology (3.7%, 95% CI −1.34 to 8.7) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.00).</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Secondary outcomes</span><p id="par0115" class="elsevierStylePara elsevierViewall">Preoperative evaluation was delayed in patients referred to Haematology, with a mean delay of 43 days (ICR of 34–65.5). The extra cost of the additional testing was estimated at €8148; i.e., €181 per patient referred.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Current evidence does not support indiscriminate coagulation testing prior to elective surgery, as it is not a reliable predictor of perioperative bleeding risk<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>. Instead, guidelines recommend the use of a structured bleeding history taking and physical examination, reserving testing for those patients whose history is indicative of a bleeding disorder<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a>. In children, such recommendations are controversial. Perioperative bleeding is widely regarded as a major cause of preventable morbidity and mortality in paediatric patients, and the detection of even a very small percentage of occult disorders is worth the time and cost<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a>. This, together with the potential difficulty in obtaining an accurate bleeding history in children, especially in younger children with little exposure to haemostatic risks, contributes to the overuse of preoperative laboratory testing.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The current policy in our hospital is to routinely screen paediatric patients with ASA III-IV for bleeding. However, we observed that most of the cases included in this study were ASA I-II, which means that in only a minority of cases was such testing indicated. Furthermore, a high percentage of the participants underwent otolaryngological surgery, including adenoidectomy (38%), tonsillectomy (11%), or both (23%). As most preoperative tests are requested by surgeons, and bleeding continues to be the most relevant complication of adenotonsillectomy in children, the desire to avoid this complication may be the reason for non-adherence to guidelines.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Unexpected prolongations of APTT and/ or PT were observed in 5.6% of children with coagulation evaluation tests. Abnormalities in standard haemostatic tests have been reported in 0.5–16%<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6,12</span></a>, with a slightly higher percentage in adult versus paediatric patients<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. Pre-anaesthetic assessment was delayed in almost half of the patients (45%), as the children were referred to the haemostasis specialist prior to surgery. The decision to request a haematological assessment appears to depend on the level of APTT and/or PT, the type of abnormality, and the presence of a positive personal or family history of bleeding. Anaesthesiologists were more likely to refer the patient when APTT and PT values were abnormal and when the prolongations obsered were high. In contrast, isolated and mild prolongations were not often investigated. We observed that the degree of APTT prolongation is not predictive of the significance of the underlying diagnosis, as mean levels were similar when we compared significant and non-significant disorders. However, in cases of prolonged PT, higher levels were more often associated with meaningful factor deficiencies. Furthermore, all but one of the 11 participants who had a positive personal or family history of haemorrhage were referred to a haematologist.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In patients evaluated by the haematologist, the main cause of unexpected prolongations was clotting factor deficiencies (31%), with factor XII deficiency being the most frequent. The prevalence of FXII deficiency in the normal population is estimated at 1.5–3%; however, it is not associated with an increased risk of bleeding<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>. Deficiency of other coagulation factors can lead to coagulopathy, causing spontaneous or post-surgical post-traumatic bleeding<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>. However, inherited coagulation defects are rare in the general population. Deficiencies of factors VIII (haemophilia A) and IX (haemophilia B) are the most common, with a prevalence of one case in 5000 and one in 30,000 males, respectively. Together with vWD, they account for 95–97% of all coagulopathies<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>. The remaining deficiencies are referred to as rare coagulation disorders and are less prevalent. In our study, 10 children had non-XII factor deficiencies. Although all of them were mild and above haemostatic levels, recommendations were made in five cases, in three of them given the presence of minor bleeding symptoms and in the remaining two, due to the type of surgery (adenotonsillectomy), which was perceived by the haematologist as entailing a high risk of bleeding. The use of antifibrinolytic drugs is generally considered in the presence of minor symptoms and prior to surgery, when it may reduce the need for factor concentrates<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In a significant number of cases, no cause for the abnormal test result was identified. The rate of APTT is variable in a normal population, and this inter-individual variability is reflected in a wide reference interval<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>. Laboratories determine a reference interval to encompass the central 95% of apparently healthy individuals with similar demographics. As a result, 2.5% of healthy subjects have a prolonged clotting time<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a>. In addition, elevations in biological substances such as C-reactive protein can interfere with APTT reagents, causing a false prolongation<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>. PT results may also vary with age and be prolonged in young children<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>. Lupus anticoagulant is another relatively common cause of prolonged APTT in children and tends to be a transient antibody typically detected after viral infections<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6,12,18</span></a>.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Only one case was diagnosed with type I vWD and desmopressin was used as prophylaxis; this patient had a family history of abnormal bleeding. Another patient had vWF levels slightly above the reference factor limit, as well as recurrent epistaxis, so vWD was suspected and tranexamic acid was recommended as prophylaxis during adenotonsillectomy. Postoperative analysis ruled out vWD. Of note, children may have lower levels of vWF than adults; however, these levels may not correlate with surgical bleeding after tonsillectomy<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In summary, 84% of children referred to haematology did not have significant bleeding disorders and no prophylactic measures were therefore taken. Haematology recommendations were made on the basis of the presence of haemorrhagic symptoms in four patients, family history in one patient, and type of surgery in two of. This means that we could have detected at least five of the seven patients requiring prophylaxis on the basis of bleeding history alone. We observed a strong correlation between positive personal or family history of bleeding and bleeding disorders requiring prophylaxis (OR 51). The diagnosis of severe bleeding disorder is usually not problematic; however, discrimination between normality and pathological bleeding tendency may be difficult in those patients who report mild bleeding symptoms, such as easy skin bruising or epistaxis<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>. Some of these may also be normal symptoms in childhood<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>. Bleeding questionnaires can help identify individuals with bleeding disorders and may be useful as a screening tool<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20–22</span></a>, although there is not yet a validated questionnaire for paediatric patients<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. Importantly, neither a negative bleeding history in a young child nor a normal coagulation test completely excludes a bleeding disorder.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Children with unexpected prolonged PTTT and/ or PT prolonged PT had similar perioperative complications whether or not they were referred to Haematology prior to surgery. Additional testing was associated with an additional cost of €181 per patient referred to Haematology, and a mean pre-operative delay of 43 days. Many clinicians rely on routine coagulation testing to identify previously undiagnosed bleeding disorders, but, as reflected in our study, asymptomatic patients are more likely to exhibit abnormal findings associated with non-significant disorders. However, significant bleeding defects are strongly associated with a positive bleeding history. On the other hand, we cannot completely rule out the possibility of bleeding disorders among patients without additional evidence; nonetheless, this group of subjects did not have a higher rate of bleeding.</p><p id="par0160" class="elsevierStylePara elsevierViewall">One limitation of this study is that we only included patients older than two years of age; consequently, our findings may not be applicable to younger patients. Similarly, as our hospital does not perform neurosurgery or cardiothoracic surgery, the results may be different in these patient cohorts. However, it has been noted that preoperative blood tests should also be selectively ordered in paediatric neurosurgery, as they do not contribute to the ultimate outcome of the procedure<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. Another limitation is the lack of standardised haemorrhagic assessment in our centre; as a result, the presence of haemorrhagic symptoms may have been under- or overestimated. Finally, changes in laboratory equipment and reagents during the study period were not taken into account and may have influenced the test results.</p><p id="par0165" class="elsevierStylePara elsevierViewall">In view of our results, we believe that referral to Haematology is of limited value in asymptomatic children with prolonged PTTT and/or PTT. Positive personal or family history of bleeding may help to identify those at increased risk of bleeding, which would also inform the need for coagulation testing and referral to Haematology. Further efforts should be made to standardise preoperative bleeding assessments in paediatric patients.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This work has received no funding of any kind.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1860770" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1617469" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1860771" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1617468" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data collection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Primary outcome measures" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Secondary outcome measures" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Data source" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Study size" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Primary outcome" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Secondary outcomes" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack655788" "titulo" => "Acknowledgement" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-06-13" "fechaAceptado" => "2021-10-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1617469" "palabras" => array:5 [ 0 => "Coagulation test" 1 => "Partial thromboplastin time" 2 => "Prothrombin time" 3 => "Blood coagulation disorders" 4 => "Surgical haemorrhage" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1617468" "palabras" => array:5 [ 0 => "Análisis de coagulación" 1 => "Tiempo de tromboplastina parcial" 2 => "Tiempo de protrombina" 3 => "Trastornos de coagulación sanguínea" 4 => "Hemorragia quirúrgica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Coagulation screening tests in children are still frequently performed in many countries to evaluate bleeding risk. The aim of this study was to assess the management of unexpected prolongations of the activated partial thromboplastin time (APTT) and prothrombine time (PT) in children prior to elective surgery, and the perioperative hemorrhagic outcomes.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Children with prolonged APTT and/or PT who attended a preoperative anesthesia consultation from January 2013 to December 2018 were included. Patients were grouped according to whether they were referred to a Hematologist or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">1835 children were screened for eligibility. 102 presented abnormal results (5.6%). Of them, 45% were referred to a Hematologist. Significant bleeding disorders were associated with a positive bleeding history, odds ratio of 51 (95% CI 4.8–538.5, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0011). No difference in perioperative hemorrhagic outcomes were found between the groups. An additional cost of 181 euros per patient and a preoperative median delay of 43 days was observed in patients referred to Hematology.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that hematology referral has limited value in asymptomatic children with a prolonged APTT and/or PT. Hemorrhagic complications were similar among patients referred and not referred to Hematology. A positive personal or family bleeding history can help identify patients with a higher bleeding risk, thus it should guide the need for coagulation testing and hematology referral. Further efforts should be made to standardize preoperative bleeding assessments tools in children.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Las pruebas de evaluación de la coagulación en niños siguen realizándose con frecuencia en muchos países, para evaluar el riesgo de hemorragia. El objetivo de este estudio fue evaluar el manejo de la prolongación imprevista del tiempo de tromboplastina parcial activada (APTT) y el tiempo de protrombina (PT) en niños previa a la cirugía electiva, y el riesgo hemorrágico perioperatorio.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se incluyó a los niños con APTT y/o PT prolongados que acudieron a consulta de anestesia preoperatoria desde enero de 2013 a diciembre de 2018. Se agrupó a los pacientes en función de si habían sido derivados a Hematología o habían sido programados para cirugía sin pruebas adicionales. El resultado primario fue comparar las complicaciones de las hemorragias perioperatorias.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se evaluó para elegibilidad a 1.835 niños. Ciento dos de ellos presentaron resultados anormales (5,6%). De ellos, el 45% fue derivado Hematología. Los trastornos hemorrágicos significativos estuvieron asociados a antecedentes hemorrágicos positivos, odds ratio de 51 (95% IC de 4,8 a 538,5, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span> 0,0011). No se encontró diferencia en términos de resultados de hemorragia perioperatoria entre los grupos. Se observó un coste adicional de 181 Euros por paciente y una demora preoperatoria media de 43 días en los pacientes derivados a Hematología.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados sugieren que la derivación a Hematología tiene un valor limitado en niños asintomáticos con APTT y/o PT prolongados. Las complicaciones hemorrágicas fueron similares entre los pacientes derivados y los no derivados a Hematología. Una historia familiar positiva de hemorragia puede ayudar a identificar a los pacientes con mayor riesgo de sangrado, por lo que servirá de guía para los análisis de coagulación y la derivación a Hematología. Deberán realizarse esfuerzos adicionales para estandarizar las herramientas preoperatorias de evaluación hemorrágica en niños.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1990 "Ancho" => 2933 "Tamanyo" => 354118 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0200" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of the study population.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">APTT: activated partial throboplastin timme; PT: prothrombin time.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1479 "Ancho" => 2925 "Tamanyo" => 251908 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0205" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Causes of prolonged APTT and PT, and both.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">APTT: activated partial thromboplastin time; LA: lupus anticoagulant; PT: prothrombin time; Miscellaneous: one or more factor deficiencies together with lupus anticoagulant vWD: von Willebrand disease.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1498 "Ancho" => 2512 "Tamanyo" => 272225 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0210" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Distribution of diagnosis by APTT (a) and PT (b) levels. APTT: activated partial thromboplastin time; PT: prothrombin time.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0215" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">APTT: Activated partial thromboplastin time; ASA: American Society of Anesthesiologists; PT: Prothrombin time.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "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">Variables \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">Referred to Haematology \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">Not referred to Haematology \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"><span class="elsevierStyleItalic">No. of patients</span> \t\t\t\t\t\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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\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"> \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"><span class="elsevierStyleItalic">Age, mean (SD), years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 (±3.9) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8 (±4.3) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.74 \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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex (%)</span></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"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\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">29 (63) \t\t\t\t\t\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">36 (64) \t\t\t\t\t\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">.9 \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"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\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">17 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (36) \t\t\t\t\t\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"> \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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ASA (%)</span></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"><span class="elsevierStyleHsp" style=""></span>I-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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (97.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (98.2) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></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"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\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 (2.2) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Risk of surgical bleeding (%)</span></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"><span class="elsevierStyleHsp" style=""></span>Low \t\t\t\t\t\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">46 (100) \t\t\t\t\t\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">54 (96) \t\t\t\t\t\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">.5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></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"><span class="elsevierStyleHsp" style=""></span>Moderate \t\t\t\t\t\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 \t\t\t\t\t\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 \t\t\t\t\t\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"> \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"><span class="elsevierStyleHsp" style=""></span>High \t\t\t\t\t\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 \t\t\t\t\t\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">2 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">History of bleeding (%)</span></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"><span class="elsevierStyleHsp" style=""></span>Staff \t\t\t\t\t\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">4 (8.7) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.17<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></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"><span class="elsevierStyleHsp" style=""></span>Family \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (13) \t\t\t\t\t\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 \t\t\t\t\t\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">.007<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Screening test result (%)</span></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"><span class="elsevierStyleHsp" style=""></span>Prolonged APTT \t\t\t\t\t\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">28 (61) \t\t\t\t\t\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">40 (71.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.26 \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"><span class="elsevierStyleHsp" style=""></span>APTT 35−40<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\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">38 \t\t\t\t\t\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"> \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"><span class="elsevierStyleHsp" style=""></span>APTT 40−45<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0316 \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"><span class="elsevierStyleHsp" style=""></span>APTT 45−50<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span>Prolonged 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0002<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></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"><span class="elsevierStyleHsp" style=""></span>PT 13−15<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\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"> \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"><span class="elsevierStyleHsp" style=""></span>PT 15−20<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span>Both \t\t\t\t\t\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">14 (30) \t\t\t\t\t\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">2 (3.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span>APTT 35−40<span class="elsevierStyleHsp" style=""></span>s. and PT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\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">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span>APTT 40−45<span class="elsevierStyleHsp" style=""></span>s. and PT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span>APTT 45−50<span class="elsevierStyleHsp" style=""></span>s. and PT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Fisher’s F test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Baseline demographics and preoperative patient characteristics.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0220" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "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">Diagnosis \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">Number (%) \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">Undetectable cause \t\t\t\t\t\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">11 (24.4) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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 deficiency \t\t\t\t\t\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">14 (31.1) \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"><span class="elsevierStyleHsp" style=""></span>FXII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (42.9) \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"><span class="elsevierStyleHsp" style=""></span>FXI \t\t\t\t\t\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 (7.1) \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"><span class="elsevierStyleHsp" style=""></span>FX \t\t\t\t\t\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">2 (14.3) \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"><span class="elsevierStyleHsp" style=""></span>FIX \t\t\t\t\t\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 (7.1) \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"><span class="elsevierStyleHsp" style=""></span>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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (14.3) \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"><span class="elsevierStyleHsp" style=""></span>Combined factors \t\t\t\t\t\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">2 (14.3) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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">Results due to artifact \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (13.3) \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">Lupus anticoagulant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (17.8) \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">Suspected or confirmed von Willebrand disease \t\t\t\t\t\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">2 (4.4) \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">Combination of causes \t\t\t\t\t\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 (6.7) \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">Others \t\t\t\t\t\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 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Diagnoses made in children referred to the Haematology.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.H. Kamal" 1 => "A. Tefferi" 2 => "R.K. Pruthi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/82.7.864" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2007" "volumen" => "82" "paginaInicial" => "864" "paginaFinal" => "873" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17605969" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Routine Preoperative Coagulation Tests in Children Undergoing Elective Surgery or Invasive Procedures: Are They Still Necessary?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Alzahrani" 1 => "N. Othman" 2 => "T. Bin-Ali" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1179545X18821158" "Revista" => array:3 [ "tituloSerie" => "Clin Med Insights Blood Disord" "fecha" => "2019" "volumen" => "12" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Routine preoperative blood testing in pediatric neurosurgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Almesbah" 1 => "T. Mandiwanza" 2 => "C. Kaliaperumal" 3 => "J. Caird" 4 => "D. Crimmins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2013.8.PEDS13254" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg Pediatr" "fecha" => "2013" "volumen" => "12" "paginaInicial" => "615" "paginaFinal" => "621" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24093590" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative screening for coagulation disorders in children undergoing adenoidectomy (AT) and tonsillectomy (TE): does it prevent bleeding complications?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Eisert" 1 => "M. Hovermann" 2 => "H. Bier" 3 => "U. Göbel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2006-942278" "Revista" => array:5 [ "tituloSerie" => "Klin Padiatr" "fecha" => "2006" "volumen" => "218" "paginaInicial" => "334" "paginaFinal" => "339" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pre-interventional haemostatic assessment: Guidelines from the French Society of Anaesthesia and Intensive Care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Bonhomme" 1 => "N. Ajzenberg" 2 => "J.F. Schved" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EJA.0b013e32835f66cd" "Revista" => array:5 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "142" "paginaFinal" => "162" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y.L. Chee" 1 => "J.C. Crawford" 2 => "H.G. Watson" 3 => "M. Greaves" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2141.2007.06968.x" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2008" "volumen" => "140" "paginaInicial" => "496" "paginaFinal" => "504" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18275427" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "J.L. Apfelbaum" 1 => "R.T. Connis" 2 => "D.J. Nickinovich" 3 => "L.R. Pasternak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e31823c1067" "Revista" => array:5 [ "tituloSerie" => "Anesthesiology" "fecha" => "2012" "volumen" => "116" "paginaInicial" => "522" "paginaFinal" => "538" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => ""Do not do" recommendations of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy. "Commitment to Quality by Scientific Societies" Project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Quecedo Gutiérrez" 1 => "R. Ruiz Abascal" 2 => "J.M. Calvo Vecino" 3 => "A.I. Peral García" 4 => "E. Matute González" 5 => "L.E. Muñoz Alameda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2016.05.002" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2016" "volumen" => "63" "paginaInicial" => "519" "paginaFinal" => "527" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27418334" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical use of the activated partial thromboplastin time and prothrombin time for screening: a review of the literature and current guidelines for testing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.H. Levy" 1 => "F. Szlam" 2 => "A.S. Wolberg" 3 => "A. Winkler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cll.2014.06.005" "Revista" => array:6 [ "tituloSerie" => "Clin Lab Med" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "453" "paginaFinal" => "477" "itemHostRev" => array:3 [ "pii" => "S0007091217302155" "estado" => "S300" "issn" => "00070912" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.R. Licameli" 1 => "D.T. Jones" 2 => "J. Santosuosso" 3 => "C. Lapp" 4 => "C. Brugnara" 5 => "M.A. Kenna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otohns.2008.06.021" "Revista" => array:5 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2008" "volumen" => "139" "paginaInicial" => "546" "paginaFinal" => "550" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-tonsillectomy hemorrhage: an assessment of risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Myssiorek" 1 => "A. Alvi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0165-5876(96)01364-x" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "1996" "volumen" => "37" "paginaInicial" => "35" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8884405" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Routine preoperative testing: a systematic review of the evidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Munro" 1 => "A. Booth" 2 => "J. Nicholl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Health Technol Assess" "fecha" => "1997" "volumen" => "1" "paginaInicial" => "1" "paginaFinal" => "62" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of moderate and severe FXII (Hageman factor) deficiency among the normal population: evaluation of the incidence of FXII deficiency among 300 healthy blood donors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W.M. Halbmayer" 1 => "A. Haushofer" 2 => "R. Schön" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thromb Haemost" "fecha" => "1994" "volumen" => "71" "paginaInicial" => "68" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8165648" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of rare factor deficiencies other than hemophilia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Menegatti" 1 => "F. Peyvandi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2018-06-820738" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2019" "volumen" => "133" "paginaInicial" => "415" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30559262" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in the treatment of bleeding disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Peyvandi" 1 => "I. Garagiola" 2 => "E. Biguzzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.13491" "Revista" => array:7 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2016" "volumen" => "14" "paginaInicial" => "2095" "paginaFinal" => "2106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27590165" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0007091219306877" "estado" => "S300" "issn" => "00070912" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus Anticoagulant (LAC) testing in patients with inflammatory status: does C-reactive protein interfere with LAC test results?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.M. Schouwers" 1 => "J.R. Delanghe" 2 => "K.M. Devreese" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thromres.2009.09.001" "Revista" => array:6 [ "tituloSerie" => "Thromb Res" "fecha" => "2010" "volumen" => "125" "paginaInicial" => "102" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19782388" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric reference values for molecular markers in hemostasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Sosothikul" 1 => "P. Seksarn" 2 => "J.M. Lusher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPH.0b013e3180308749" "Revista" => array:5 [ "tituloSerie" => "J Pediatr Hematol Oncol" "fecha" => "2007" "volumen" => "29" "paginaInicial" => "19" "paginaFinal" => "22" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Causes of isolated prolonged activated partial thromboplastin time in an acute care general hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.J. Chng" 1 => "C. Sum" 2 => "P. Kuperan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Singapore Med J" "fecha" => "2005" "volumen" => "46" "paginaInicial" => "450" "paginaFinal" => "456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16123828" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low VWF levels in children and lack of association with bleeding in children undergoing tonsillectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.C. Gill" 1 => "S.F. Conley" 2 => "V.P. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/bloodadvances.2019000992" "Revista" => array:7 [ "tituloSerie" => "Blood Adv" "fecha" => "2020" "volumen" => "4" "paginaInicial" => "100" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31905240" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0007091217337650" "estado" => "S300" "issn" => "00070912" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of mild bleeding disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. de Moerloose" 1 => "E. Levrat" 2 => "P. Fontana" 3 => "F. Boehlen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4414/smw.2009.12476" "Revista" => array:6 [ "tituloSerie" => "Swiss Med Wkly" "fecha" => "2009" "volumen" => "139" "paginaInicial" => "327" "paginaFinal" => "332" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19529990" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening for haemorrhagic disorders in paediatric patients by means of a questionnaire" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Music" 1 => "M. Novak" 2 => "B. Acham-Roschitz" 3 => "W. Muntean" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Hamostaseologie" "fecha" => "2009" "volumen" => "29" "numero" => "Suppl 1" "paginaInicial" => "S87" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19763360" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coagulation tests or standardized questionnaire, which is better as a predictor of bleeding? A prospective study among children before tonsillectomy and/or adenoidectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Masalha" 1 => "A. DeRowe" 2 => "S. Mazzawi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13104-020-05020-6" "Revista" => array:5 [ "tituloSerie" => "BMC Res Notes" "fecha" => "2020" "volumen" => "13" "paginaInicial" => "175" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32204728" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack655788" "titulo" => "Acknowledgement" "texto" => "<p id="par0180" class="elsevierStylePara elsevierViewall">We would like to express our sincere gratitude to Dr. J. Gómez-Arnau for his help with this document.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000002/v1_202303141745/S2341192923000264/v1_202303141745/en/main.assets" "Apartado" => array:4 [ "identificador" => "34051" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000002/v1_202303141745/S2341192923000264/v1_202303141745/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000264?idApp=UINPBA00004N" ]
