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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El incremento de la edad de la poblaci&#243;n y el aumento de la incidencia y de la prevalencia de enfermedades cardiovasculares cr&#243;nicas&#44; como la enfermedad ateroscler&#243;tica y la fibrilaci&#243;n auricular&#44; han hecho aumentar los pacientes que requieren tratamiento antitromb&#243;tico cr&#243;nico y que vayan a ser sometidos a intervenciones o procedimientos diagn&#243;sticos o terap&#233;uticos invasivos<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En estas situaciones&#44; la decisi&#243;n de retirar o mantener los antiagregantes o anticoagulantes viene determinada por el balance entre el riesgo tromb&#243;tico del paciente y el riesgo hemorr&#225;gico de la intervenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46; Se han publicado diversos documentos de consenso sobre este tema<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; entre ellos un documento espa&#241;ol certificado por m&#225;s de 20 sociedades cient&#237;ficas<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; El seguimiento de estas recomendaciones en Espa&#241;a ha sido recientemente analizado en el estudio REQXAA<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#44; que incluy&#243; 1&#46;266 pacientes sometidos a diversos tipos de cirug&#237;a o procedimientos invasivos&#44; observ&#225;ndose que el abordaje del tratamiento antitromb&#243;tico periprocedimiento fue inadecuado en casi la mitad de los casos&#44; y que esto se asoci&#243; a una mayor incidencia de eventos tromb&#243;ticos y hemorr&#225;gicos a los 30 d&#237;as&#46; Una situaci&#243;n muy frecuente&#44; poco estudiada hasta ahora&#44; es la de los pacientes que toman anticoagulantes orales y&#47;o antiagregantes plaquetarios sometidos a procedimientos dentales&#46; Con el objetivo de evaluar su abordaje en estas situaciones&#44; hemos analizado los resultados del estudio REQXAA en el subgrupo de paciente sometidos a procedimientos bucodentales&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; de acuerdo con la Declaraci&#243;n de Helsinki&#44; fue aprobado por el Comit&#233; &#201;tico del Hospital Cl&#237;nico San Carlos de Madrid y autorizado por el resto de los centros participantes&#46; Todos los pacientes firmaron el consentimiento informado&#46; El objetivo principal del estudio fue la incidencia del evento adverso cl&#237;nico neto a 30 d&#237;as tras la intervenci&#243;n&#44; definido como el combinado de&#58; mortalidad por cualquier causa&#44; infarto de miocardio&#44; trombosis del <span class="elsevierStyleItalic">stent</span>&#44; ictus isqu&#233;mico&#44; embolia perif&#233;rica&#44; enfermedad tromboemb&#243;lica venosa y&#47;o complicaciones hemorr&#225;gicas de grado &#62;<span class="elsevierStyleHsp" style=""></span>2 seg&#250;n la clasificaci&#243;n BARC&#46; El uso apropiado&#47;inadecuado del tratamiento antitromb&#243;tico fue valorado por investigadores independientes mediante la aplicaci&#243;n web QXAApp&#44; desarrollada para aplicar las recomendaciones del documento de consenso espa&#241;ol<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Del total de los 1&#46;266 pacientes de la serie global&#44; 149 &#40;11&#44;8&#37;&#41; fueron sometidos a procedimientos bucodentales&#46; La edad fue de 68&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3 a&#241;os &#40;menor que la de la serie global&#44; 72&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;7&#41;&#44; y el 26&#44;8&#37; eran mujeres &#40;frente al 36&#44;5&#37; de la serie global&#41;&#46; El riesgo tromb&#243;tico de los pacientes era bajo en el 84&#44;3&#37; y el riesgo hemorr&#225;gico de la intervenci&#243;n bajo en el 97&#44;3&#37; de los casos&#46; En la serie global del REQXAA&#44; la proporci&#243;n de pacientes con riesgo tromb&#243;tico y hemorr&#225;gico bajo fue mucho menor &#40;66&#44;7 y 51&#44;9&#37;&#44; respectivamente&#41;&#46; El abordaje del tratamiento antitromb&#243;tico fue inadecuado en 24 pacientes &#40;16&#44;1&#37;&#41;&#44; proporci&#243;n inferior a la de la serie global&#44; en donde fue del 42&#44;7&#37;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se recogen las caracter&#237;sticas de los grupos de abordaje adecuado e inadecuado en los procedimientos dentales&#46; No hubo diferencias estad&#237;sticamente significativas entre ambos grupos en la mayor&#237;a de las variables&#44; con la excepci&#243;n del sexo y de una tendencia a un riesgo hemorr&#225;gico m&#225;s alto en dicho grupo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; La incidencia a 30 d&#237;as del evento combinado fue m&#225;s alta en el grupo de abordaje inadecuado &#40;8&#44;3 frente al 0&#37;&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41;&#44; a expensas de dos eventos graves en dicho grupo &#40;un infarto de miocardio y una hemorragia grave que requiri&#243; retirar el tratamiento antitromb&#243;tico&#41;&#46; La incidencia de hemorragias leves tambi&#233;n fue mayor en el grupo de abordaje inadecuado &#40;14&#44;3 frente al 6&#44;6&#37;&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Nuestro trabajo tiene algunas limitaciones&#44; inherentes a su dise&#241;o no experimental aleatorizado&#44; al peque&#241;o tama&#241;o muestral&#44; y a la baja incidencia de eventos graves&#46; Sin embargo&#44; refuerzan la validez de sus resultados el que sea un registro multic&#233;ntrico&#44; con una recogida de la informaci&#243;n prospectiva y sistem&#225;tica&#44; y que los resultados muestren una tendencia similar a la de la serie global del REQXAA en la relaci&#243;n entre un abordaje inadecuado y un peor pron&#243;stico&#46; En conclusi&#243;n&#44; el seguimiento de las recomendaciones sobre el abordaje del tratamiento antitromb&#243;tico en procedimientos bucodentales en Espa&#241;a fue mejor que el hallado en otros procedimientos o cirug&#237;as&#44; aunque sigui&#243; siendo inadecuado en el 16&#37; de los casos&#46; Un abordaje inadecuado se asoci&#243; a una mayor tasa de eventos graves tambi&#233;n en procedimientos dentales&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Consideraciones &#233;ticas</span><p id="par0025" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; de acuerdo con la Declaraci&#243;n de Helsinki&#44; fue aprobado por el Comit&#233; &#201;tico del Hospital Cl&#237;nico San Carlos de Madrid&#46; Todos los pacientes aceptaron su participaci&#243;n por escrito mediante la firma del consentimiento informado&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financiaci&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">los autores declaran no tener ninguna financiaci&#243;n para este trabajo&#46;</p></span></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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