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de los casos de TVP de miembros superiores y 1-4&#37; del total de TVP&#44; con una edad media de presentaci&#243;n entre 30-40<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; de predominio en hombres&#44; en la extremidad superior dominante y en relaci&#243;n con actividades de esfuerzo<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las manifestaciones cl&#237;nicas var&#237;an en severidad&#44; pero habitualmente se presenta como dolor axilo-humeral&#44; edema en la extremidad&#44; cianosis y circulaci&#243;n colateral a nivel del hombro&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La ecograf&#237;a doppler suele ser la primera prueba diagn&#243;stica&#44; con especificidad del 93&#37; y sensibilidad mayor del 80&#37;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Otros estudios de imagen&#44; como TAC o RNM&#44; son adecuados para indagar otras causas de compresi&#243;n o confirmar el diagn&#243;stico ante una alta sospecha pero con resultado ecogr&#225;fico normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Cuando no se realiza un tratamiento precoz&#44; se genera una reacci&#243;n fibr&#243;tica intraluminal que conduce a hipertensi&#243;n venosa cr&#243;nica y aparici&#243;n del s&#237;ndrome postromb&#243;tico &#40;SPT&#41;&#44; que en algunos casos puede generar discapacidad funcional significativa y afectaci&#243;n severa de la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La estrategia terap&#233;utica m&#225;s eficaz es controvertida&#46; Las gu&#237;as actuales recomiendan la anticoagulaci&#243;n convencional&#44; aunque dejan abierta la posibilidad en centros experimentados de realizar tromb&#243;lisis local guiada por cat&#233;ter y cirug&#237;a de liberaci&#243;n de la salida tor&#225;cica<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Observaci&#243;n cl&#237;nica</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se llev&#243; a cabo un estudio prospectivo entre noviembre de 2011 y mayo de 2013&#44; donde fueron incluidos 5 hombres y 3 mujeres&#44; con sintomatolog&#237;a aguda y cl&#237;nica compatible con SPS&#44; a los cuales se confirm&#243; la TVP por ecograf&#237;a doppler&#46; Tras el ingreso&#44; se aplic&#243; un protocolo establecido que incluy&#243;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Historia cl&#237;nica detallada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Anal&#237;tica completa con d&#237;mero D&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">TAC din&#225;mico de la extremidad afectada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Flebograf&#237;a inicial mediante punci&#243;n de vena bas&#237;lica&#44; colocando cat&#233;ter multiperforado al sobrepasar la oclusi&#243;n venosa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Trombol&#237;sis local con urocinasa &#40;100&#46;000<span class="elsevierStyleHsp" style=""></span>UI&#47;100<span class="elsevierStyleHsp" style=""></span>ml&#47;h&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Flebograf&#237;a de control&#46; Categorizamos el resultado de la tromb&#243;lisis en <span class="elsevierStyleItalic">exitosa</span>&#44; si en la flebograf&#237;a de control no objetivamos trombo residual&#44; <span class="elsevierStyleItalic">parcialmente exitosa</span>&#44; si el trombo persistente es menor del 50&#37; del trombo inicial&#44; y <span class="elsevierStyleItalic">no exitosa</span>&#44; si el trombo persistente es mayor del 50&#37; del trombo inicial&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Heparina de bajo peso molecular &#40;HBPM&#41; a dosis terap&#233;uticas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Cirug&#237;a de liberaci&#243;n de la salida tor&#225;cica que incluy&#243; desinserci&#243;n escal&#233;nica anterior y extirpaci&#243;n del primer arco costal por v&#237;a axilar&#44; seg&#250;n t&#233;cnica de Ross&#44; dentro de las 16 semanas siguientes al diagn&#243;stico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">HBPM durante un mes a dosis terap&#233;uticas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Estudio de trombofilia a los 3 meses tras la cirug&#237;a&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Seguimiento cl&#237;nico cada 6 meses hasta la fecha&#44; con cuantificaci&#243;n del SPT con la escala de Villalta<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> en cada control&#46;</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">Tras la aplicaci&#243;n del protocolo y hasta el momento&#44; ning&#250;n paciente ha presentado complicaciones o recurrencias tromb&#243;ticas&#46; Uno de los 8 pacientes present&#243; datos leves de SPT &#40;escala de Villalta&#41;&#44; sin impedir realizar su actividad laboral diaria&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Durante muchos a&#241;os el tratamiento del SPS inclu&#237;a la elevaci&#243;n de la extremidad y la anticoagulaci&#243;n&#44; considerando la opci&#243;n quir&#250;rgica solo ante la recurrencia de s&#237;ntomas<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a>&#46; Las gu&#237;as actuales recomiendan como tratamiento inicial la anticoagulaci&#243;n parenteral de preferencia a ning&#250;n tratamiento&#44; durante un m&#237;nimo de 3<span class="elsevierStyleHsp" style=""></span>meses&#46; Asimismo&#44; en pacientes seleccionados con bajo riesgo de sangrado y s&#237;ntomas severos de reciente aparici&#243;n recomiendan la tromb&#243;lisis guiada con cat&#233;ter en centros experimentados&#44; as&#237; como la resecci&#243;n de la primera costilla y la liberaci&#243;n escal&#233;nica ante la sospecha de atrapamiento de la vena subclavia<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la terapia exclusiva con anticoagulaci&#243;n&#44; se ha visto que esta tendencia est&#225; perdiendo adeptos&#44; ya que algunos estudios han objetivado que bajo este tratamiento se presentan tasas de obstrucci&#243;n venosa residual cercanas al 80&#37; de los casos y s&#237;ntomas de congesti&#243;n venosa persistente hasta en el 90&#37; de ellos<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En cuanto a la intervenci&#243;n quir&#250;rgica&#44; las opiniones difieren con respecto al momento oportuno de realizaci&#243;n&#44; aunque los estudios con series m&#225;s largas han comparado los tiempos quir&#250;rgicos&#44; concluyendo que la tromb&#243;lisis seguida de intervenci&#243;n quir&#250;rgica precoz es la estrategia que mejores resultados cl&#237;nicos ofrece<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="par0115" class="elsevierStylePara elsevierViewall">El SPS es una entidad poco frecuente que afecta a individuos j&#243;venes y sanos&#44; en el cual es primordial establecer un diagn&#243;stico precoz para obtener una repermeabilizaci&#243;n venosa adecuada&#46; En nuestra serie de casos&#44; el diagn&#243;stico y la actuaci&#243;n precoz&#44; de acuerdo con lo descrito en la literatura de vanguardia&#44; han permitido que la evoluci&#243;n y los resultados sean favorables hasta el momento&#46; El manejo multidisciplinar mediante tromb&#243;lisis local guiada por cat&#233;ter y cirug&#237;a descompresiva precoz&#44; realizado con un grupo m&#233;dico multidisciplinar experimentado&#44; presenta resultados satisfactorios&#44; sin complicaciones relevantes y una incidencia mucho menor de SPT comparado con el tratamiento conservador&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicto de intereses</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los autores declaran que no existe ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Introducci&#243;n"
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          "titulo" => "Observaci&#243;n cl&#237;nica"
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          "titulo" => "Discusi&#243;n"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusiones"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicto de intereses"
        ]
        9 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-03-22"
    "fechaAceptado" => "2014-09-09"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec597271"
          "palabras" => array:4 [
            0 => "S&#237;ndrome de Paget-Schroetter"
            1 => "Trombosis venosa profunda de extremidad superior"
            2 => "S&#237;ndrome de la salida del t&#243;rax"
            3 => "Trombosis de esfuerzo"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec597272"
          "palabras" => array:4 [
            0 => "Paget-Schroetter syndrome"
            1 => "Upper extremity deep vein thrombosis"
            2 => "Thoracic outlet syndrome"
            3 => "Effort thrombosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de Paget-Schroetter &#40;SPS&#41; en el contexto de trombosis venosa profunda &#40;TVP&#41; de miembro superior es una patolog&#237;a poco frecuente pero de gran importancia por afectar personas sanas y j&#243;venes&#44; donde el s&#237;ndrome postromb&#243;tico &#40;SPT&#41; secundario puede ser una complicaci&#243;n con importantes implicaciones&#46; La mejor opci&#243;n de tratamiento es controvertida&#46; Las gu&#237;as actuales recomiendan anticoagulaci&#243;n durante un m&#237;nimo de 3<span class="elsevierStyleHsp" style=""></span>meses&#44; aunque se han visto con este manejo incidencias de SPT cercanas al 50&#37; a los 6<span class="elsevierStyleHsp" style=""></span>meses&#44; al 30&#37; al a&#241;o y al 25&#37; a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; por lo que unidades especializadas abogan por la realizaci&#243;n de tromb&#243;lisis local y cirug&#237;a descompresiva precoz&#44; con el prop&#243;sito de disminuir estas cifras&#46; Describimos una serie de 8 casos&#44; a los que tratamos de esta &#250;ltima manera&#46; Ning&#250;n paciente present&#243; complicaciones&#44; y en todos se observ&#243; reintegro precoz a la actividad diaria&#44; con ausencia de SPT en el 90&#37; de ellos&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Paget-Schroetter syndrome &#40;PSS&#41; in the context of upper extremity deep venous thrombosis &#40;DVT&#41; is an uncommon but potentially very serious condition affecting young&#44; healthy adults&#44; in which secondary post-thrombotic syndrome &#40;PTS&#41; can be a complication with major implications&#46; The best treatment option remains controversial&#44; with current guidelines recommending anticoagulation for at least 3 months&#46; However&#44; an incidence of PTS of approximately 50&#37; after 6 months&#44; 30&#37; after 1 year and 25&#37; after 2 years has been found using this therapeutic approach&#46; Consequently&#44; specialized units recommend local thrombolysis and early decompressive surgery&#46; We describe a series of eight cases treated in this way&#46; None of the patients showed signs of complications&#44; and an early return to regular activities with no PTS was observed in 90&#37; of cases&#46;</p></span>"
      ]
    ]
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FPM&#58; factor predisponente mec&#225;nico</p>"
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                  <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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Peso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FPM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Musculaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uso de muletas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Levantamiento de peso en f&#225;brica de golosinas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Musculaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mozo de almac&#233;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pirag&#252;ista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cocinera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Musculaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">D&#237;mero D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">670<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;930<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;830<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;950<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;600<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1380<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">540<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">310<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Trombofilia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tromb&#243;lisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Parcial &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HBPM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enoxaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cirug&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SPT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tiempo libre de recurrencia tromb&#243;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">971 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">849 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">634 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">605 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">532 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">510 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">456 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">279 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Nota clínica
Manejo multidisciplinar del síndrome de Paget-Schroetter. A propósito de una serie de 8 casos
Multidisciplinary Management of Paget-Schroetter Syndrome. A Case Series of Eight Patients
Vladimir Rosa Salazara,
Corresponding author
Vladi_medico@yahoo.es

Autor para correspondencia.
, Sonia del Pilar Otálora Valderramab, María Encarnación Hernández Contrerasa, Bartolomé García Péreza, Andrés del Amor Arroyo Tristánc, María del Mar García Méndeza
a Unidad de Corta Estancia/Trombosis, Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
b Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
c Servicio de Cirugía Torácica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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de los casos de TVP de miembros superiores y 1-4&#37; del total de TVP&#44; con una edad media de presentaci&#243;n entre 30-40<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; de predominio en hombres&#44; en la extremidad superior dominante y en relaci&#243;n con actividades de esfuerzo<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las manifestaciones cl&#237;nicas var&#237;an en severidad&#44; pero habitualmente se presenta como dolor axilo-humeral&#44; edema en la extremidad&#44; cianosis y circulaci&#243;n colateral a nivel del hombro&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La ecograf&#237;a doppler suele ser la primera prueba diagn&#243;stica&#44; con especificidad del 93&#37; y sensibilidad mayor del 80&#37;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Otros estudios de imagen&#44; como TAC o RNM&#44; son adecuados para indagar otras causas de compresi&#243;n o confirmar el diagn&#243;stico ante una alta sospecha pero con resultado ecogr&#225;fico normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Cuando no se realiza un tratamiento precoz&#44; se genera una reacci&#243;n fibr&#243;tica intraluminal que conduce a hipertensi&#243;n venosa cr&#243;nica y aparici&#243;n del s&#237;ndrome postromb&#243;tico &#40;SPT&#41;&#44; que en algunos casos puede generar discapacidad funcional significativa y afectaci&#243;n severa de la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La estrategia terap&#233;utica m&#225;s eficaz es controvertida&#46; Las gu&#237;as actuales recomiendan la anticoagulaci&#243;n convencional&#44; aunque dejan abierta la posibilidad en centros experimentados de realizar tromb&#243;lisis local guiada por cat&#233;ter y cirug&#237;a de liberaci&#243;n de la salida tor&#225;cica<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Observaci&#243;n cl&#237;nica</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se llev&#243; a cabo un estudio prospectivo entre noviembre de 2011 y mayo de 2013&#44; donde fueron incluidos 5 hombres y 3 mujeres&#44; con sintomatolog&#237;a aguda y cl&#237;nica compatible con SPS&#44; a los cuales se confirm&#243; la TVP por ecograf&#237;a doppler&#46; Tras el ingreso&#44; se aplic&#243; un protocolo establecido que incluy&#243;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Historia cl&#237;nica detallada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Anal&#237;tica completa con d&#237;mero D&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">TAC din&#225;mico de la extremidad afectada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Flebograf&#237;a inicial mediante punci&#243;n de vena bas&#237;lica&#44; colocando cat&#233;ter multiperforado al sobrepasar la oclusi&#243;n venosa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Trombol&#237;sis local con urocinasa &#40;100&#46;000<span class="elsevierStyleHsp" style=""></span>UI&#47;100<span class="elsevierStyleHsp" style=""></span>ml&#47;h&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Flebograf&#237;a de control&#46; Categorizamos el resultado de la tromb&#243;lisis en <span class="elsevierStyleItalic">exitosa</span>&#44; si en la flebograf&#237;a de control no objetivamos trombo residual&#44; <span class="elsevierStyleItalic">parcialmente exitosa</span>&#44; si el trombo persistente es menor del 50&#37; del trombo inicial&#44; y <span class="elsevierStyleItalic">no exitosa</span>&#44; si el trombo persistente es mayor del 50&#37; del trombo inicial&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Heparina de bajo peso molecular &#40;HBPM&#41; a dosis terap&#233;uticas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Cirug&#237;a de liberaci&#243;n de la salida tor&#225;cica que incluy&#243; desinserci&#243;n escal&#233;nica anterior y extirpaci&#243;n del primer arco costal por v&#237;a axilar&#44; seg&#250;n t&#233;cnica de Ross&#44; dentro de las 16 semanas siguientes al diagn&#243;stico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">HBPM durante un mes a dosis terap&#233;uticas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Estudio de trombofilia a los 3 meses tras la cirug&#237;a&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Seguimiento cl&#237;nico cada 6 meses hasta la fecha&#44; con cuantificaci&#243;n del SPT con la escala de Villalta<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> en cada control&#46;</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">Tras la aplicaci&#243;n del protocolo y hasta el momento&#44; ning&#250;n paciente ha presentado complicaciones o recurrencias tromb&#243;ticas&#46; Uno de los 8 pacientes present&#243; datos leves de SPT &#40;escala de Villalta&#41;&#44; sin impedir realizar su actividad laboral diaria&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Durante muchos a&#241;os el tratamiento del SPS inclu&#237;a la elevaci&#243;n de la extremidad y la anticoagulaci&#243;n&#44; considerando la opci&#243;n quir&#250;rgica solo ante la recurrencia de s&#237;ntomas<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a>&#46; Las gu&#237;as actuales recomiendan como tratamiento inicial la anticoagulaci&#243;n parenteral de preferencia a ning&#250;n tratamiento&#44; durante un m&#237;nimo de 3<span class="elsevierStyleHsp" style=""></span>meses&#46; Asimismo&#44; en pacientes seleccionados con bajo riesgo de sangrado y s&#237;ntomas severos de reciente aparici&#243;n recomiendan la tromb&#243;lisis guiada con cat&#233;ter en centros experimentados&#44; as&#237; como la resecci&#243;n de la primera costilla y la liberaci&#243;n escal&#233;nica ante la sospecha de atrapamiento de la vena subclavia<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la terapia exclusiva con anticoagulaci&#243;n&#44; se ha visto que esta tendencia est&#225; perdiendo adeptos&#44; ya que algunos estudios han objetivado que bajo este tratamiento se presentan tasas de obstrucci&#243;n venosa residual cercanas al 80&#37; de los casos y s&#237;ntomas de congesti&#243;n venosa persistente hasta en el 90&#37; de ellos<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En cuanto a la intervenci&#243;n quir&#250;rgica&#44; las opiniones difieren con respecto al momento oportuno de realizaci&#243;n&#44; aunque los estudios con series m&#225;s largas han comparado los tiempos quir&#250;rgicos&#44; concluyendo que la tromb&#243;lisis seguida de intervenci&#243;n quir&#250;rgica precoz es la estrategia que mejores resultados cl&#237;nicos ofrece<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="par0115" class="elsevierStylePara elsevierViewall">El SPS es una entidad poco frecuente que afecta a individuos j&#243;venes y sanos&#44; en el cual es primordial establecer un diagn&#243;stico precoz para obtener una repermeabilizaci&#243;n venosa adecuada&#46; En nuestra serie de casos&#44; el diagn&#243;stico y la actuaci&#243;n precoz&#44; de acuerdo con lo descrito en la literatura de vanguardia&#44; han permitido que la evoluci&#243;n y los resultados sean favorables hasta el momento&#46; El manejo multidisciplinar mediante tromb&#243;lisis local guiada por cat&#233;ter y cirug&#237;a descompresiva precoz&#44; realizado con un grupo m&#233;dico multidisciplinar experimentado&#44; presenta resultados satisfactorios&#44; sin complicaciones relevantes y una incidencia mucho menor de SPT comparado con el tratamiento conservador&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicto de intereses</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los autores declaran que no existe ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Introducci&#243;n"
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          "titulo" => "Observaci&#243;n cl&#237;nica"
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          "titulo" => "Discusi&#243;n"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusiones"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicto de intereses"
        ]
        9 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-03-22"
    "fechaAceptado" => "2014-09-09"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec597271"
          "palabras" => array:4 [
            0 => "S&#237;ndrome de Paget-Schroetter"
            1 => "Trombosis venosa profunda de extremidad superior"
            2 => "S&#237;ndrome de la salida del t&#243;rax"
            3 => "Trombosis de esfuerzo"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec597272"
          "palabras" => array:4 [
            0 => "Paget-Schroetter syndrome"
            1 => "Upper extremity deep vein thrombosis"
            2 => "Thoracic outlet syndrome"
            3 => "Effort thrombosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de Paget-Schroetter &#40;SPS&#41; en el contexto de trombosis venosa profunda &#40;TVP&#41; de miembro superior es una patolog&#237;a poco frecuente pero de gran importancia por afectar personas sanas y j&#243;venes&#44; donde el s&#237;ndrome postromb&#243;tico &#40;SPT&#41; secundario puede ser una complicaci&#243;n con importantes implicaciones&#46; La mejor opci&#243;n de tratamiento es controvertida&#46; Las gu&#237;as actuales recomiendan anticoagulaci&#243;n durante un m&#237;nimo de 3<span class="elsevierStyleHsp" style=""></span>meses&#44; aunque se han visto con este manejo incidencias de SPT cercanas al 50&#37; a los 6<span class="elsevierStyleHsp" style=""></span>meses&#44; al 30&#37; al a&#241;o y al 25&#37; a los 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; por lo que unidades especializadas abogan por la realizaci&#243;n de tromb&#243;lisis local y cirug&#237;a descompresiva precoz&#44; con el prop&#243;sito de disminuir estas cifras&#46; Describimos una serie de 8 casos&#44; a los que tratamos de esta &#250;ltima manera&#46; Ning&#250;n paciente present&#243; complicaciones&#44; y en todos se observ&#243; reintegro precoz a la actividad diaria&#44; con ausencia de SPT en el 90&#37; de ellos&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Paget-Schroetter syndrome &#40;PSS&#41; in the context of upper extremity deep venous thrombosis &#40;DVT&#41; is an uncommon but potentially very serious condition affecting young&#44; healthy adults&#44; in which secondary post-thrombotic syndrome &#40;PTS&#41; can be a complication with major implications&#46; The best treatment option remains controversial&#44; with current guidelines recommending anticoagulation for at least 3 months&#46; However&#44; an incidence of PTS of approximately 50&#37; after 6 months&#44; 30&#37; after 1 year and 25&#37; after 2 years has been found using this therapeutic approach&#46; Consequently&#44; specialized units recommend local thrombolysis and early decompressive surgery&#46; We describe a series of eight cases treated in this way&#46; None of the patients showed signs of complications&#44; and an early return to regular activities with no PTS was observed in 90&#37; of cases&#46;</p></span>"
      ]
    ]
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FPM&#58; factor predisponente mec&#225;nico</p>"
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                  <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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caso 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Peso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FPM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Musculaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uso de muletas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Levantamiento de peso en f&#225;brica de golosinas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Musculaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mozo de almac&#233;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pirag&#252;ista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cocinera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Musculaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Derecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Izquierdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">D&#237;mero D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">670<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;930<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;830<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;950<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;600<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1380<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">540<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">310<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Trombofilia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tromb&#243;lisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Parcial &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exitosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HBPM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enoxaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cirug&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SPT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tiempo libre de recurrencia tromb&#243;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">971 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">849 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">634 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">605 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">532 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">510 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">456 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">279 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 03002896
Original language: Spanish
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2022 February 285 42 327
2022 January 346 35 381
2021 December 233 60 293
2021 November 227 65 292
2021 October 301 64 365
2021 September 308 58 366
2021 August 231 46 277
2021 July 339 36 375
2021 June 258 40 298
2021 May 290 54 344
2021 April 457 82 539
2021 March 250 46 296
2021 February 174 40 214
2021 January 163 30 193
2020 December 208 33 241
2020 November 229 23 252
2020 October 208 28 236
2020 September 160 22 182
2020 August 210 25 235
2020 July 278 24 302
2020 June 338 26 364
2020 May 245 34 279
2020 April 158 23 181
2020 March 292 16 308
2020 February 236 35 271
2020 January 205 20 225
2019 December 176 33 209
2019 November 188 38 226
2019 October 240 26 266
2019 September 681 24 705
2019 August 564 27 591
2019 July 442 21 463
2019 June 717 28 745
2019 May 719 33 752
2019 April 857 52 909
2019 March 458 48 506
2019 February 444 27 471
2019 January 494 27 521
2018 December 554 31 585
2018 November 656 49 705
2018 October 507 32 539
2018 September 320 17 337
2018 July 1 0 1
2018 May 64 2 66
2018 April 154 10 164
2018 March 115 21 136
2018 February 114 14 128
2018 January 82 26 108
2017 December 73 11 84
2017 November 101 15 116
2017 October 137 24 161
2017 September 97 16 113
2017 August 95 16 111
2017 July 88 27 115
2017 June 99 41 140
2017 May 130 24 154
2017 April 79 17 96
2017 March 98 28 126
2017 February 230 26 256
2017 January 86 20 106
2016 December 113 21 134
2016 November 198 25 223
2016 October 185 26 211
2016 September 267 22 289
2016 August 166 26 192
2016 July 141 22 163
2016 June 170 62 232
2016 May 118 16 134
2016 April 79 3 82
2016 March 78 2 80
2016 February 80 6 86
2016 January 101 38 139
2015 December 89 33 122
2015 November 105 30 135
2015 October 23 4 27
2015 September 7 0 7
2015 August 56 0 56
2015 July 2 0 2
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