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Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical
Pharmacological venous thromboembolism prophylaxis in radical prostatectomy
Sebastian Valverde-Martineza,b, Laura-Andrea Gonzalez-Rayoc, Barbara Padilla-Fernandezd, Jorge Pereira-Brunoe, Hugo Coelhof, Manuel Montesino-Semperg, Carlos Müller-Arteagah, Jose-Luis Alvarez-Ossorio-Fernandezi, Filippo Migliorinij, Maria-Begoña Garcia-Cenadork, Maria-Fernanda Lorenzo-Gomeza,k,l,
Autor para correspondencia
mflorenzogo@yahoo.es

Autor para correspondencia.
a Grupo de Investigación Multidisciplinar Urológico de Renal (GRUMUR), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
b Servicio de Urología, Complejo Asistencial Universitario de Ávila, Ávila, España
c Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
d Servicio de Urología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
e Servicio de Urología, Hospital Universitário Pêro da Covilhã, Covilhã, Portugal
f Servicio de Urología, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
g Servicio de Urología, Hospital Universitario Virgen del Camino, Pamplona, España
h Servicio de Urología, Complejo Universitario Hospitalario de Ourense, Ourense, España
i Servicio de Urología, Hospital Universitario Puerta del Mar, Cádiz, España
j Servicio de Urología, Hospital Azienda Ospedaliera Universitaria Integrata, Verona, Italia
k Departamento de Cirugía, Universidad de Salamanca, Salamanca, España
l Servicio de Urología, Hospital Universitario de Salamanca, Salamanca, España
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            "entidad" => "Servicio de Urolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario Virgen del Camino&#44; Pamplona&#44; Espa&#241;a"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Complejo Universitario Hospitalario de Ourense&#44; Ourense&#44; Espa&#241;a"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario Puerta del Mar&#44; C&#225;diz&#44; Espa&#241;a"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Azienda Ospedaliera Universitaria Integrata&#44; Verona&#44; Italia"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Departamento de Cirug&#237;a&#44; Universidad de Salamanca&#44; Salamanca&#44; Espa&#241;a"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
          11 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario de Salamanca&#44; Salamanca&#44; Espa&#241;a"
            "etiqueta" => "l"
            "identificador" => "aff0060"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
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    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Pharmacological venous thromboembolism prophylaxis in radical prostatectomy"
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    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El c&#225;ncer de pr&#243;stata es el segundo c&#225;ncer m&#225;s com&#250;nmente diagnosticado en los hombres&#44; con un estimado de 1&#44;1<span class="elsevierStyleHsp" style=""></span>millones de diagn&#243;sticos en todo el mundo en 2012&#44; lo que representa el 15&#37; de todos los c&#225;nceres en ese a&#241;o<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los c&#225;nceres de pr&#243;stata presentan un estadio &#243;rgano-confinado en el momento del diagn&#243;stico&#46; Cuando la esperanza de vida del paciente es igual o superior a 10<span class="elsevierStyleHsp" style=""></span>a&#241;os y su estado de salud es compatible con una anestesia general&#44; uno de los tratamientos m&#225;s resolutivos en t&#233;rminos oncol&#243;gicos es la prostatectom&#237;a radical<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46; La prostatectom&#237;a radical es una cirug&#237;a mayor abdominop&#233;lvica compleja&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La ausencia de estandarizaci&#243;n al momento de clasificar y publicar las complicaciones quir&#250;rgicas de la prostatectom&#237;a radical&#44; as&#237; como la introducci&#243;n de diferentes t&#233;cnicas&#44; han dado lugar a una amplia variaci&#243;n en los tipos de complicaciones informadas&#44; as&#237; como a la variaci&#243;n en la incidencia global de las complicaciones<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La enfermedad tromboemb&#243;lica venosa &#40;ETV&#41;&#44; que comprende la trombosis venosa profunda &#40;TVP&#41; y el tromboembolismo pulmonar &#40;TEP&#41;&#44; son complicaciones frecuentes de los procedimientos quir&#250;rgicos&#46; El TEP es una de las causas m&#225;s comunes de muerte no quir&#250;rgica en pacientes sometidos a cirug&#237;a urol&#243;gica<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Adem&#225;s de la mortalidad asociada con el TEP&#44; a largo plazo las complicaciones como los s&#237;ndromes postromb&#243;ticos conllevan una morbilidad importante y un impacto econ&#243;mico significativo<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El TEP tambi&#233;n representa la causa de muerte prevenible m&#225;s com&#250;n relacionada con la hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&#46; Previamente a que la profilaxis para evitar el TEP durante la cirug&#237;a abdominop&#233;lvica se convirtiese en una rutina&#44; la incidencia de TVP se encontraba entre el 10 y el 30&#37; y la incidencia de TEP&#44; entre el 1 y el 10&#37;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Estos hallazgos llevaron a realizar recomendaciones para la tromboprofilaxis de rutina en pacientes que van a someterse a una cirug&#237;a urol&#243;gica abdominop&#233;lvica<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2-4</span></a>&#46; Con la profilaxis de la enfermedad tromboemb&#243;lica las cifras de TEP han descendido entre el 0 y el 2&#44;0&#37;&#44; seg&#250;n distintas series<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Las opciones terap&#233;uticas para la tromboprofilaxis dependen del nivel de riesgo del paciente para desarrollar un evento tromboemb&#243;lico venoso&#46; En el entorno quir&#250;rgico las terapias a utilizar de forma individual o combinada son las siguientes<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#58;</p><p id="par0035" class="elsevierStylePara elsevierViewall">1&#46; Terapias mec&#225;nicas &#40;no farmacol&#243;gicas&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Deambulaci&#243;n temprana&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Medias de compresi&#243;n gradual&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Compresi&#243;n neum&#225;tica intermitente&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">2&#46; Agentes farmacol&#243;gicos<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Dosis bajas de heparina no fraccionada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Heparinas de bajo peso molecular&#46;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">La profilaxis farmacol&#243;gica de la trombosis venosa consiste en el uso de heparina no fraccionada a dosis bajas o heparina de bajo peso molecular &#40;HBPM&#41;&#59; debe iniciarse antes de la inducci&#243;n anest&#233;sica&#44; ya que se ha comprobado que los fen&#243;menos tromb&#243;ticos comienzan durante la cirug&#237;a&#46; Con frecuencia estas complicaciones tromboemb&#243;licas tienen lugar despu&#233;s del alta hospitalaria&#44; ya que el riesgo de desarrollar un evento tromboemb&#243;lico venoso es casi constante durante las primeras 4<span class="elsevierStyleHsp" style=""></span>semanas tras la cirug&#237;a<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;6</span></a>&#44; por lo es recomendable informar a los pacientes de los signos y s&#237;ntomas acompa&#241;antes de dichos eventos cl&#237;nicos&#46; En base a esto &#250;ltimo&#44; la recomendaci&#243;n general es mantener la profilaxis farmacol&#243;gica durante 4<span class="elsevierStyleHsp" style=""></span>semanas tras la cirug&#237;a<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#44; y lo que a&#250;n es un tema de debate es si esta deber&#237;a iniciarse el d&#237;a previo a la intervenci&#243;n o el d&#237;a posterior a la misma para no aumentar el riesgo de sangrado intraoperatorio y postoperatorio&#44; ya que la reducci&#243;n del riesgo tromboemb&#243;lico al decantarnos por una u otra opci&#243;n a&#250;n no est&#225; clara<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ensayos cl&#237;nicos controlados y aleatorizados han demostrado la eficacia de la tromboprofilaxis en la reducci&#243;n de la incidencia de los eventos tromboemb&#243;licos venosos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#44; y algunos metaan&#225;lisis en cirug&#237;a abdominop&#233;lvica de varias especialidades han demostrado que los anticoagulantes como las HBPM reducen el riesgo relativo de ETV en aproximadamente un 50&#37;&#44; pero tambi&#233;n aumentan el riesgo relativo de hemorragia mayor en aproximadamente el 50&#37;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;7&#44;8</span></a>&#59; por lo tanto&#44; la administraci&#243;n de la profilaxis de la ETV debe equilibrarse con los riesgos de un sangrado excesivo&#44; en particular en los pacientes quir&#250;rgicos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Diversas organizaciones &#8212;entre ellas la Asociaci&#243;n Espa&#241;ola de Urolog&#237;a&#8212; encuentran que la profilaxis de la enfermedad tromboemb&#243;lica es un indicador de la buena calidad de la atenci&#243;n al paciente<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; La existencia de variaciones en los cuidados de salud conlleva muchas preguntas sobre la calidad de la atenci&#243;n&#44; incluyendo aspectos de accesibilidad&#44; adecuaci&#243;n&#44; coste-efectividad y equidad&#46; Estas cuestiones plantean las implicaciones que la variabilidad en la pr&#225;ctica m&#233;dica tiene para la pol&#237;tica sanitaria y la pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A pesar de la importancia de la profilaxis del TEP tras la prostatectom&#237;a radical&#44; se sabe poco sobre los patrones de uso de la profilaxis por los ur&#243;logos&#46; Series multic&#233;ntricas han demostrado amplia variaci&#243;n en la utilizaci&#243;n de esta profilaxis&#44; incluso entre instituciones de alto volumen<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46; Una encuesta de ur&#243;logos realizada en 2004 inform&#243; que el 24&#37; de los ur&#243;logos estadounidenses utilizaron profilaxis farmacol&#243;gica&#44; frente al 100&#37; de los ur&#243;logos brit&#225;nicos y el 50&#37; de los irlandeses&#46; No hubo diferencias en el uso de dispositivos mec&#225;nicos<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#46; Las pautas de la profilaxis para la enfermedad tromboemb&#243;lica no siempre han sido bien recibidas por los ur&#243;logos&#44; y en algunos consensos incluso se ha recomendado la movilizaci&#243;n precoz y la terapia mec&#225;nica en lugar de la profilaxis farmacol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Dada la escasez de datos existentes que describan la profilaxis de la enfermedad tromboemb&#243;lica posterior a la prostatectom&#237;a&#44; se realiz&#243; un an&#225;lisis de los predictores de la enfermedad tromboemb&#243;lica&#44; de la variabilidad cl&#237;nica en la utilizaci&#243;n de la profilaxis farmacol&#243;gica para esta enfermedad y de los resultados de su aplicaci&#243;n entre los hombres sometidos a prostatectom&#237;a radical en las 3<span class="elsevierStyleHsp" style=""></span>t&#233;cnicas m&#225;s utilizadas en la actualidad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se realiza un estudio observacional multic&#233;ntrico de car&#225;cter retrospectivo&#46; Se revisaron los historiales cl&#237;nicos de 610 varones intervenidos mediante prostatectom&#237;a radical por c&#225;ncer de pr&#243;stata &#243;rgano-confinado en 7<span class="elsevierStyleHsp" style=""></span>hospitales de Italia&#44; Portugal y Espa&#241;a&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Selecci&#243;n de los pacientes</span><p id="par0100" class="elsevierStylePara elsevierViewall">La selecci&#243;n de la cohorte se realiz&#243; tomando como referencia las fechas del 1 diciembre de 2013 hasta el 31 de noviembre de 2014&#44; seleccionando los casos secuencialmente de forma sucesiva y retrospectiva hasta alcanzar el tama&#241;o muestral adecuado&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los pacientes fueron atendidos en&#58; Hospital Universitario de Salamanca &#40;Espa&#241;a&#41;&#44; Hospital Universitario P&#234;ro da Covilh&#227; &#40;Portugal&#41;&#44; Centro Hospitalar e Universit&#225;rio de Coimbra &#40;Portugal&#41;&#44; Hospital Universitario Virgen del Camino de Pamplona &#40;Espa&#241;a&#41;&#44; Complejo Universitario Hospitalario de Ourense &#40;Espa&#241;a&#41;&#44; Hospital Universitario Puerta del Mar de C&#225;diz &#40;Espa&#241;a&#41; y Hospital Azienda Ospedaliera Universitaria Integrata de Verona &#40;Italia&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Debido al protocolo del estudio solo se especificaba que se mencionar&#237;a el grupo de hospital nivel<span class="elsevierStyleHsp" style=""></span>III o nivel<span class="elsevierStyleHsp" style=""></span>IV o el car&#225;cter p&#250;blico o privado&#47;concertado&#44; pero en ning&#250;n caso se realizar&#237;a menci&#243;n expresa al nombre del hospital&#46; Se distinguen&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">a&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Grupo de centro 1&#58; hospital general nivel<span class="elsevierStyleHsp" style=""></span>4 p&#250;blico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>153&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">b&#41;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Grupo de centro 2&#58; hospital general nivel<span class="elsevierStyleHsp" style=""></span>3 p&#250;blico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">c&#41;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Grupo de centro 3&#58; hospital general nivel<span class="elsevierStyleHsp" style=""></span>3 privado&#47;concertado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">d&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Grupo de centro 4&#58; hospital general nivel<span class="elsevierStyleHsp" style=""></span>3 p&#250;blico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>73&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">e&#41;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Grupo de centros 5 y 6&#58; dos hospitales generales nivel<span class="elsevierStyleHsp" style=""></span>3 p&#250;blicos&#59; presentaron datos conjuntos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">f&#41;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Grupo de centro 7&#58; general nivel<span class="elsevierStyleHsp" style=""></span>4 p&#250;blico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Caracter&#237;sticas del paciente y del hospital</span><p id="par0145" class="elsevierStylePara elsevierViewall">Debido a que la utilizaci&#243;n de la profilaxis tromboemb&#243;lica implica un riesgo espec&#237;fico en el procedimiento y para el paciente&#44; y que sopesa el beneficio de la reducci&#243;n de los eventos tromboemb&#243;licos venosos versus el aumento del sangrado intraoperatorio y postoperatorio&#44; se definieron varios grupos de pacientes seg&#250;n sus caracter&#237;sticas basales&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Por un lado&#44; se defini&#243; a los pacientes con predisposici&#243;n para presentar hemorragias intraoperatorias y postoperatorias&#44; valorando las variables referentes a presentar alguna enfermedad que induzca a la hipocoagulabilidad o los tratamientos con anticoagulantes o con antiagregantes plaquetarios previos a la cirug&#237;a&#44; a pesar de que&#44; en todos los pacientes con estos tratamientos&#44; se les realiz&#243; una terapia puente para llevar a cabo el procedimiento&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Con respecto a la hemorragia como complicaci&#243;n derivada del uso de f&#225;rmacos para la profilaxis tromboemb&#243;lica&#44; se valoraron el sangrado intraoperatorio y la necesidad de transfusi&#243;n durante el ingreso hospitalario&#46; Estas variables se tomaron en cuenta debido a que aproximadamente el 50&#37; de las hemorragias importantes se producen entre la cirug&#237;a y la ma&#241;ana siguiente&#44; y cerca del 90&#37; durante los primeros 4<span class="elsevierStyleHsp" style=""></span>d&#237;as tras la cirug&#237;a<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Por otro lado&#44; se defini&#243; a pacientes con caracter&#237;sticas predisponentes a presentar un evento tromboemb&#243;lico venoso tras una intervenci&#243;n quir&#250;rgica &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#46; Aunque existen varios modelos cuantitativos para estimar el riesgo de sufrir un evento&#44; en nuestro estudio se utiliz&#243; el modelo de riesgo de tromboembolia venoso seg&#250;n los factores de riesgo del paciente&#44; que incluye como variables&#58; la edad&#44; el &#237;ndice de masa corporal&#44; ETV previa o antecedentes de la misma en un familiar de primer grado<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#44;14&#44;15</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">En este estudio se defini&#243; evento tromboemb&#243;lico venoso cuando el paciente present&#243; una TVP sintom&#225;tica o un TEP&#46; En todos los casos&#44; como profilaxis farmacol&#243;gica se utiliz&#243; HBPM a dosis profil&#225;ctica&#46; La m&#225;s com&#250;nmente utilizada fue enoxaparina a dosis de 4&#46;000<span class="elsevierStyleHsp" style=""></span>unidades internacionales &#40;UI&#41; o 40<span class="elsevierStyleHsp" style=""></span>mg&#44; independientemente del peso del paciente&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Es importante se&#241;alar que en nuestro estudio se indic&#243; en todos los casos la deambulaci&#243;n temprana a las 24<span class="elsevierStyleHsp" style=""></span>h tras la intervenci&#243;n&#44; y solo en el 10&#37; de los casos se utiliz&#243; la compresi&#243;n neum&#225;tica intermitente&#44; por lo que mayoritariamente este trabajo eval&#250;a la profilaxis farmacol&#243;gica&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Otro grupo de estudio relacion&#243; los eventos tromboemb&#243;licas seg&#250;n los diferentes tipos de cirug&#237;a&#58; prostatectom&#237;a laparosc&#243;pica&#44; abierta o retrop&#250;bica o rob&#243;tica&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Se analizan los resultados con estad&#237;stica descriptiva e inferencial&#44; utilizando t de Student&#44; chi-cuadrado&#44; test exacto de Fisher&#44; an&#225;lisis de la varianza ANOVA &#40;con test de Scheffe&#39;s para muestras normales y Kruskal Wallys para otras distribuciones&#41;&#46; Se acept&#243; una significaci&#243;n estad&#237;stica para p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los resultados del estudio se muestran en las <a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2-7</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0190" class="elsevierStylePara elsevierViewall">Desde 2004&#44; cuando <span class="elsevierStyleItalic">The American College of Chest Physicians</span> present&#243; varias recomendaciones para la profilaxis de la ETV en pacientes que van a ser intervenidos de una cirug&#237;a urol&#243;gica abdominop&#233;lvica&#44; los diferentes tipos de profilaxis se han ido adecuando seg&#250;n los diferentes abordajes quir&#250;rgicos&#44; entre ellos la prostatectom&#237;a radical&#46; Entre estas medidas tenemos la deambulaci&#243;n precoz&#44; la compresi&#243;n neum&#225;tica intermitente y las HBPM&#44; siendo actualmente el manejo recomendado una combinaci&#243;n de estas medidas&#44; independientemente de la t&#233;cnica a emplear<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;4</span></a>&#46; En nuestra serie&#44; 15<span class="elsevierStyleHsp" style=""></span>pacientes &#40;2&#44;5&#37;&#41; presentaron eventos tromboemb&#243;licos venosos&#46; Nueve de ellos presentaron un TEP grave que en ning&#250;n caso caus&#243; el fallecimiento del paciente&#46; Ocho de los pacientes que presentaron un evento no recibieron profilaxis farmacol&#243;gica&#46; Observamos que con respecto a la profilaxis farmacol&#243;gica empleada en los diferentes grupos de riesgo tromboemb&#243;lico &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; existieron diferencias en el grupo de bajo riesgo y no en los grupos de riesgo intermedio y alto&#59; esto probablemente fue debido a que este grupo abarcaba el 95&#37; de los casos de la serie &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Sin embargo&#44; sus resultados reflejan la importancia de la profilaxis farmacol&#243;gica para prevenir la ETV&#44; ya que existieron diferencias entre los pacientes que recibieron profilaxis y los que no&#59; adem&#225;s&#44; esta profilaxis fue capaz de reducir hasta un 6&#44;8&#37; los eventos tromboemb&#243;licos en el estudio &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Sin embargo&#44; es importante comentar que en este estudio no se han valorado otros factores tromboemb&#243;licos de riesgo&#44; y que en futuros trabajos podr&#237;an ser analizados como la realizaci&#243;n de linfadenectom&#237;a p&#233;lvica&#44; la duraci&#243;n del procedimiento quir&#250;rgico&#44; los trastornos hereditarios de la sangre como los s&#237;ndromes de anticuerpos antifosfol&#237;pidos&#44; factor<span class="elsevierStyleHsp" style=""></span>V de Leiden&#44; antitrombina&#44; deficiencias de prote&#237;na C o S<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">A pesar de que la variabilidad en la pr&#225;ctica cl&#237;nica es un fen&#243;meno muy frecuente en nuestra labor asistencial&#44; en este trabajo existieron diferencias poco relevantes en el uso de los diferentes tipos de profilaxis para la ETV entre los diferentes hospitales&#46; Al evaluar diferencias entre las distintas t&#233;cnicas empleadas con respecto a la incidencia de eventos tromboemb&#243;licos venosos&#44; no se observaron diferencias entre estas &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Es importante se&#241;alar que en la serie investigada&#44; que incluye pacientes de hospitales de diferente nivel asistencial&#44; la indicaci&#243;n de la profilaxis est&#225; influenciada por &#171;la pr&#225;ctica habitual&#187; del ur&#243;logo respecto al tipo y al momento de aplicarla&#46; En el 15&#44;4&#37; de los casos no se utiliz&#243; ning&#250;n tipo de profilaxis&#44; excepto la deambulaci&#243;n temprana&#59; en el 4&#44;1&#37; se utiliz&#243; compresi&#243;n neum&#225;tica intermitente&#59; en el 84&#44;6&#37;&#44; profilaxis farmacol&#243;gica &#40;HBPM&#41;&#44; y solo en el 3&#44;4&#37; la combinaci&#243;n de estas &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Por lo tanto&#44; si bien no hay una variabilidad cl&#237;nica evidente entre los diferentes grupos al momento de utilizar las diversas medidas profil&#225;cticas&#44; s&#237; existe poca adherencia a las gu&#237;as cl&#237;nicas al utilizar la CMI solo en el 4&#44;1&#37; de los pacientes&#44; y peor a&#250;n&#44; un tratamiento combinado&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; en 361 pacientes &#40;59&#44;1&#37;&#41; se aplic&#243; la profilaxis farmacol&#243;gica &#40;HBPM&#41; entre las 8 y 24<span class="elsevierStyleHsp" style=""></span>h tras el procedimiento quir&#250;rgico&#44; mientras que en el resto de los casos se aplic&#243; 12<span class="elsevierStyleHsp" style=""></span>h antes de la cirug&#237;a&#46; Como se mencion&#243; previamente&#44; el momento id&#243;neo para iniciar la profilaxis a&#250;n no est&#225; del todo claro&#46; El tiempo de mantenimiento de la profilaxis farmacol&#243;gica vari&#243; entre 7 y 40<span class="elsevierStyleHsp" style=""></span>d&#237;as&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Respecto al riesgo de complicaciones hemorr&#225;gicas por el uso de profilaxis farmacol&#243;gica tromboemb&#243;lica&#44; se ha encontrado que las tasas de sangrado intraoperatorio son similares y no presentan diferencias entre los grupos de riesgo hemorr&#225;gico&#44; y tampoco entre los pacientes que recibieron o no profilaxis &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabla 7</a>&#41;&#46; De igual manera&#44; tampoco se observaron diferencias cuando se valor&#243; la necesidad de transfusi&#243;n sangu&#237;nea en el postoperatorio de los pacientes del estudio &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabla 7</a>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0215" class="elsevierStylePara elsevierViewall">En un estudio sobre pacientes sometidos a prostatectom&#237;a radical no hubo diferencia en las complicaciones hemorr&#225;gicas derivadas del uso de profilaxis farmacol&#243;gica &#40;HBPM&#41; para la ETV&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">La profilaxis farmacol&#243;gica reduce el riesgo de presentar un evento tromboemb&#243;lico en pacientes sometidos a prostatectom&#237;a radical&#44; si bien este riesgo no se asocia con la t&#233;cnica de abordaje&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">No existe variabilidad cl&#237;nica importante entre los diferentes centros&#59; por otro lado&#44; s&#237; se observ&#243; poca adherencia a las recomendaciones de las diferentes gu&#237;as cl&#237;nicas vigentes en la aplicaci&#243;n de la profilaxis tromboemb&#243;lica&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">En pacientes sometidos a prostatectom&#237;a radical con o sin factores de riesgo para desarrollar un evento tromboemb&#243;lico estar&#237;a indicado un tratamiento profil&#225;ctico que combine movilizaci&#243;n precoz y profilaxis farmacol&#243;gica con HBPM&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0235" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflicto de intereses&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tromboembolismo pulmonar es una de las causas m&#225;s comunes de muerte no quir&#250;rgica en pacientes sometidos a cirug&#237;a urol&#243;gica abdominop&#233;lvica&#46; Desde el inicio de la profilaxis para la enfermedad tromboemb&#243;lica venosa los episodios de trombosis venosa profunda y tromboembolia pulmonar han descendido considerablemente&#46; Nuestro objetivo es analizar los predictores de la enfermedad tromboemb&#243;lica&#44; la variabilidad cl&#237;nica en la utilizaci&#243;n de la profilaxis farmacol&#243;gica para esta enfermedad y los resultados de su aplicaci&#243;n&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo multic&#233;ntrico de 610 pacientes intervenidos mediante prostatectom&#237;a radical entre diciembre de 2013 y noviembre de 2014 en 7<span class="elsevierStyleHsp" style=""></span>hospitales generales de Espa&#241;a&#44; Italia y Portugal&#46; Se clasific&#243; a los pacientes seg&#250;n sus caracter&#237;sticas basales en grupos de riesgo tromb&#243;tico y grupos de riesgo hemorr&#225;gico&#46; Se evaluaron los eventos tromboemb&#243;licos venosos que se presentaron en los diferentes grupos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La edad media fue de 65&#44;22<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;48-78&#41;&#46; El &#237;ndice de masa corporal medio fue de 26&#44;7 y la mediana del riesgo de ASA fue 2&#46; En todos los pacientes se inici&#243; la deambulaci&#243;n en las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#46; En el 4&#44;1&#37; se utiliz&#243; compresi&#243;n neum&#225;tica intermitente y en el 84&#44;6&#37;&#44; profilaxis farmacol&#243;gica con heparinas de bajo peso molecular&#46; Solo en el 3&#44;4&#37; se utiliz&#243; la combinaci&#243;n de profilaxis mec&#225;nica con la farmacol&#243;gica&#46; Se observ&#243; disminuci&#243;n de la incidencia de eventos tromboemb&#243;licos en los pacientes que recibieron profilaxis farmacol&#243;gica&#44; con una reducci&#243;n absoluta del riesgo del 6&#44;8&#37;&#46; No se objetiv&#243; aumento del riesgo hemorr&#225;gico en los pacientes que recibieron profilaxis tromboemb&#243;lica&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En este estudio sobre pacientes sometidos a prostatectom&#237;a radical no hubo diferencia en las complicaciones hemorr&#225;gicas derivadas del uso de profilaxis farmacol&#243;gica para la enfermedad tromboemb&#243;lica venosa&#46; La profilaxis farmacol&#243;gica reduce el riesgo de presentar un evento tromboemb&#243;lico en pacientes sometidos a prostatectom&#237;a radical&#44; si bien este riesgo no se asocia con la t&#233;cnica de abordaje&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and aim</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery&#46; Since the beginning of prophylaxis for venous thromboembolic disease&#44; episodes of deep vein thrombosis and pulmonary thromboembolism have decreased&#46; Our objective is to analyse the prognosis factors of thromboembolic disease&#44; the clinical variability in the use of pharmacological prophylaxis and the results of its application&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014&#44; in 7<span class="elsevierStyleHsp" style=""></span>general hospitals in Spain&#44; Italy and Portugal&#46; Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups&#46; The venous thromboembolic events that occurred in the different groups were analysed&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The average age was 65&#46;22<span class="elsevierStyleHsp" style=""></span>years &#40;48-78&#41;&#46; The average body mass index was 26&#46;7 and the average ASA risk 2&#46;1&#46; In all patients&#44; early mobilization began in the first 24<span class="elsevierStyleHsp" style=""></span>hours&#46; In 4&#46;1&#37; intermittent pneumatic compression was used and 84&#46;6&#37; received pharmacological prophylaxis with low molecular weight heparins&#46; Only 3&#46;4&#37; used the combination of mechanical prophylaxis with pharmacological prophylaxis&#46; We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis&#44; with an absolute risk reduction of 6&#46;8&#37;&#46; There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In this study on patients undergoing radical prostatectomy&#44; there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease&#46; Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy&#44; although this risk is not associated with the approach technique&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Modelo de riesgo tromboemb&#243;lico venoso seg&#250;n factores de riesgo del paciente</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ASA&#58; sistema de clasificaci&#243;n de la <span class="elsevierStyleItalic">American Society of Anesthesiologists</span> para estimar el riesgo anest&#233;sico&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; IMC&#58; &#237;ndice de masa corporal&#59; PSA&#58; ant&#237;geno prost&#225;tico espec&#237;fico&#59; TNM&#58; sistema de clasificaci&#243;n tumoral&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo con profilaxis tromboemb&#243;lica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Edad &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;86 &#40;6&#44;09 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;34 &#40;4&#44;57 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMC &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;73 &#40;4&#44;45 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;43 &#40;3&#44;68 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASA &#40;mediana&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSA &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;19 &#40;3&#44;54 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;54 &#40;7&#44;01 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gleason de la biopsia &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;41 &#40;0&#44;70 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;43 &#40;1&#44;27 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carga tumoral &#40;&#37; cilindros afectados&#41; &#40;media&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&#44;89 &#40;22&#44;77 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;75 &#40;22&#44;32 DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">cTNM<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mediana&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;3-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pTNM<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;mediana&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1-5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;1-5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">D&#237;as de estancia hospitalaria &#40;mediana&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2-10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2-8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Eventos tromboemb&#243;licos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cantidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&nbsp;\t\t\t\t\t\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">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2236509.png"
              ]
            ]
          ]
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No eventos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RRA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Riesgo bajo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>No profilaxis&nbsp;\t\t\t\t\t\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">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;080 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Profilaxis&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">484&nbsp;\t\t\t\t\t\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">491&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;012 &#40;1&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>Total&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">565&nbsp;\t\t\t\t\t\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">578&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">Riesgo intermedio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>No profilaxis&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>Profilaxis&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">19&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>Total&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">Riesgo alto</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>No profilaxis&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>Profilaxis&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>Total&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2236511.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Eventos tromboemb&#243;licos venosos en hombres sometidos a prostatectom&#237;a radical seg&#250;n los grupos de riesgo tromboemb&#243;lico y el uso de profilaxis farmacol&#243;gica tromboemb&#243;lica</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabla 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Riesgo bajo&#58; paciente sin factores de riesgo hemorr&#225;gico&#59; Riesgo alto&#58; paciente con enfermedad que induzca a la hipocoagulabilidad o en tratamiento con anticoagulantes o con antiagregantes plaquetarios previo a la cirug&#237;a&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cirug&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No profilaxis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Profilaxis farmacol&#243;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Riesgo bajo</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>Cantidad&nbsp;\t\t\t\t\t\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">478&nbsp;\t\t\t\t\t\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">72&nbsp;\t\t\t\t\t\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">406&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Porcentaje&nbsp;\t\t\t\t\t\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">78&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Riesgo alto</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>Cantidad&nbsp;\t\t\t\t\t\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">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\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">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Porcentaje&nbsp;\t\t\t\t\t\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">21&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\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">610&nbsp;\t\t\t\t\t\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">94&nbsp;\t\t\t\t\t\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">516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Porcentaje&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2236512.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Uso de profilaxis tromboemb&#243;lica venosa en hombres sometidos a prostatectom&#237;a radical seg&#250;n grupos de riesgo hemorr&#225;gico</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0035"
        "etiqueta" => "Tabla 7"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at7"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cirug&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sangrado intraoperatorio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transfusi&#243;n postoperatoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-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">Riesgo bajo</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No profilaxis&nbsp;\t\t\t\t\t\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">72&nbsp;\t\t\t\t\t\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">Media 296&#44;8 cc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>Profilaxis&nbsp;\t\t\t\t\t\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">406&nbsp;\t\t\t\t\t\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">Media 316&#44;4 cc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">Riesgo alto</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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>No profilaxis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\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">Media 358&#44;4 cc&nbsp;\t\t\t\t\t\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&#44;16&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Profilaxis&nbsp;\t\t\t\t\t\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">110&nbsp;\t\t\t\t\t\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">Media 425&#44;8 cc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">Total</span>&nbsp;\t\t\t\t\t\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">610&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Eventos hemorr&#225;gicos en hombres sometidos a prostatectom&#237;a radical seg&#250;n los grupos de riesgo hemorr&#225;gico y el uso de profilaxis farmacol&#243;gica tromboemb&#243;lica</p>"
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                0 => array:1 [
                  "referenciaCompleta" => "Mottet N&#44; van den Bergh RCN&#44; Vice-chair PC&#44; de Santis M&#44; Gillessen S&#44; Govorov A&#44; et al&#46; EAU-ESUR-ESTRO-SIOG Guidelines on Prostate Cancer&#46; Guidelines of the European Association of Urology&#46; 2018 &#91;consultado 10 Dic 2018&#93;&#46; Disponible en&#58; http&#58;&#47;&#47;uroweb&#46;org&#47;guideline&#47;prostate-cancer&#47;"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Nationwide practice patterns for the use of venous thromboembolism prophylaxis among men undergoing radical prostatectomy"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Weinberg"
                            1 => "J&#46; Wright"
                            2 => "C&#46; Deibert"
                            3 => "Y&#46;S&#46; Lu"
                            4 => "D&#46; Hershman"
                            5 => "A&#46; Neugut"
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                      "doi" => "10.1007/s00345-013-1212-2"
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                        "tituloSerie" => "World J Urol&#46;"
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                        "volumen" => "32"
                        "paginaInicial" => "1313"
                        "paginaFinal" => "1321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24292076"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous thromboembolism &#40;VTE&#41; prophylaxis and urological pelvic cancer surgery&#58; A UK national audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "P&#46; Allchorne"
                            2 => "B&#46; Turner"
                            3 => "J&#46; Peters"
                            4 => "J&#46; Green"
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                    0 => array:2 [
                      "doi" => "10.1111/bju.12693"
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                        "tituloSerie" => "BJU Int&#46;"
                        "fecha" => "2015"
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                        "paginaInicial" => "223"
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                          0 => array:2 [
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                0 => array:1 [
                  "referenciaCompleta" => "Tikkinen K&#46;A&#46;O&#46;&#44; Cartwright R&#46;&#44; Gould M&#46;K&#46;&#44; Naspro R&#46;&#44; Novara G&#46;&#44; Sandset P&#46;M&#46;&#44; et al&#46; EAU Guidelines on Thromboprophylaxis in Urological Surgery&#46; En&#58; Guidelines of the European Association of Urology&#46; 2018 &#91;consultado 10 Dic 2018&#93;&#46; Disponible en&#58; http&#58;&#47;&#47;uroweb&#46;org&#47;guideline&#47;thromboprophylaxis&#47;"
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                      "titulo" => "Prevention of venous thromboembolism&#58; American College of Chest Physicians Evidence-Based Clinical Practice Guidelines &#40;8th edition&#41;"
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                        0 => array:2 [
                          "etal" => false
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                            3 => "J&#46; Heit"
                            4 => "C&#46; Samama"
                            5 => "M&#46; Lassen"
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                      "doi" => "10.1378/chest.08-0656"
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              "etiqueta" => "7"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procedure-specific risks of thrombosis and bleeding in urological cancer surgery&#58; Systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;A&#46;O&#46; Tikkinen"
                            1 => "S&#46; Craigie"
                            2 => "A&#46; Agarwal"
                            3 => "P&#46;D&#46; Violette"
                            4 => "G&#46; Novara"
                            5 => "R&#46; Cartwright"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2017.03.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol&#46;"
                        "fecha" => "2018"
                        "volumen" => "73"
                        "paginaInicial" => "242"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guideline of guidelines&#58; Thromboprophylaxis for urological surgery"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;D&#46; Violette"
                            1 => "R&#46; Cartwright"
                            2 => "M&#46; Briel"
                            3 => "K&#46;A&#46;O&#46; Tikkinen"
                            4 => "G&#46;H&#46; Guyatt"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bju.13496"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int&#46;"
                        "fecha" => "2016"
                        "volumen" => "118"
                        "paginaInicial" => "351"
                        "paginaFinal" => "358"
                        "link" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Indicadores de Calidad Asistencial en Urolog&#237;a"
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                          "etal" => false
                          "autores" => array:1 [
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                      "Libro" => array:2 [
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              "etiqueta" => "10"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Variabilidad de la pr&#225;ctica cl&#237;nica urol&#243;gica en c&#225;ncer de pr&#243;stata en Espa&#241;a"
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                          "autores" => array:5 [
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                            4 => "J&#46;A&#46; Portillo"
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                        "paginaInicial" => "333"
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                0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            2 => "A&#46; Bjartell"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2007.05.028"
                      "Revista" => array:6 [
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Información del artículo
ISSN: 00257753
Idioma original: Español
DOI:10.1016/j.medcli.2019.04.023
Datos actualizados diariamente
año/Mes Html Pdf Total
2023 Octubre 1 0 1
2020 Octubre 2 3 5
2020 Agosto 3 2 5
2020 Junio 5 0 5
2020 Mayo 1 2 3
2020 Marzo 3 4 7
2020 Febrero 6 6 12

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