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Carta al Director
Consenso multidisciplinar, ¿falta alguien?
Multidisciplinary Consensus, Is Anyone Missing?
Juan José Ciampi-Dopazoa,
Corresponding author
juanciampi@hotmail.com

Autor para correspondencia.
, José Andrés Guirolab, José Urbanoc, Miguel Angel de Gregoriob
a Radiología Intervencionista, Hospital Virgen de las Nieves, Granada, España
b Radiología Intervencionista, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
c Radiología Intervencionista, Hospital Ramón y Cajal, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemos le&#237;do con agrado el Consenso multidisciplinar para el manejo de la TEP&#44; publicado &#171;<span class="elsevierStyleItalic">on line</span>&#187; en Arch de Broneumol 2021<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Es un trabajo contundente y en la l&#237;nea de otros consensos actuales europeos y americanos&#46; No obstante&#44; desde la perspectiva de la Radiolog&#237;a Intervencionista nos gustar&#237;a hacer algunas matizaciones en referencia al tratamiento fibrinol&#237;tico para el manejo del TEP masivo y submasivo&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Son bien conocidos los efectos de la fibrin&#243;lisis sist&#233;mica sobre la reducci&#243;n de la mortalidad a dosis completa&#44; a pesar de que ello conlleve un incremento del riesgo de sangrado mayor &#40;hemorragia intracraneal&#41;&#44; que alcanza hasta el 9&#44;2&#37; en el uso conjunto de los anticoagulante<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>fibrinol&#237;ticos<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; En los &#250;ltimos a&#241;os se han reportado en la literatura estudios&#44; de considerable valor metodol&#243;gico<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; donde se reporta y analiza el impacto de la trombectom&#237;a pulmonar unida a la fibrin&#243;lisis local en la mejor&#237;a cl&#237;nica y reducci&#243;n de la mortalidad secundaria a embolia pulmonar masiva y submasiva&#46; Estos estudios tambi&#233;n destacan la importante reducci&#243;n del riesgo de sangrado mayor al limitar las dosis del trombol&#237;tico&#44; dado que la administraci&#243;n es local y dispensada a trav&#233;s de cat&#233;ter<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Por otra parte&#44; es subrayable que la recomendaci&#243;n de la fibrin&#243;lisis sist&#233;mica frente a la local est&#225; basada en el art&#237;culo de Verstraete et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> quienes en 1988 publicaron un estudio comparativo en 34 pacientes con TEP masivo administrando rt-PA intraarterial &#40;arteria pulmonar&#41; e intravenoso sist&#233;mico consiguiendo similares resultados&#46; En la actualidad no tiene ning&#250;n sentido esta comparaci&#243;n ya que la fibrin&#243;lisis local siempre se realiza intratrombo adem&#225;s de ir acompa&#241;ada de fragmentaci&#243;n o aspiraci&#243;n del trombo&#46; Por consiguiente&#44; opinamos&#44; que con el conocimiento actual&#44; la fibrin&#243;lisis local intraarterial no puede quedar relegada&#44; &#250;nicamente a la contraindicaci&#243;n relativa o absoluta de la fibrin&#243;lisis sist&#233;mica en el TEP masivo&#47;submasivo&#44; porque aunque los resultados en mejor&#237;a son similares&#44; se disminuye de forma dr&#225;stica el riesgo de sangrado&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En el Registro PERFECT<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#44; estudio americano&#44; multic&#233;ntrico&#44; prospectivo en 101 pacientes tratados con catheter-directed therapy el &#233;xito cl&#237;nico fue del 85&#44;7&#37; en TEP masivo y del 97&#44;3&#37; para el TEP submasivo sin complicaciones mayores hemorr&#225;gicas&#46; A pesar de estos resultados&#44; es obvio&#44; el estudio no proporciona la evidencia cl&#237;nica de un estudio randomizado pero&#44; en nuestra opini&#243;n&#44; deber&#237;a tener peso en la toma de decisiones terap&#233;uticas en una enfermedad que sigue matando&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ser&#237;a imprescindible realizar estudios randomizados que comparen tanto resultados inmediatos&#44; complicaciones y costos de una y otra t&#233;cnica&#40;fibrin&#62;lisis sist&#233;mica vs&#46; fibrin&#62;lisis<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>trombectom&#237;a mec&#225;nica o aspiraci&#243;n&#41;&#46; Finalmente debemos destacar la importancia del equipo multidisciplinar en el que juegan un papel importante los m&#233;dicos de Urgencias&#44; intensivistas y anestesi&#243;logos&#44; radi&#243;logos&#44; neum&#243;logos e intervencionistas&#44; ya que sin su soporte no ser&#237;a posible el manejo global del tromboembolismo pulmonar grave&#46;</p></span>"
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                            3 => "M&#46; Kadakia"
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                            2 => "P&#46;S&#46; Kim"
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                            4 => "J&#46;P&#46; Colle"
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Article information
ISSN: 03002896
Original language: Spanish
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