Editorial
Lack of Funding for Direct-Acting Oral Anticoagulants for the Treatment of Pulmonary Embolism in Spain: Why and Until When
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Multidisciplinary approach (respiratory physicians, endocrinologists, dietitians, <span class="elsevierStyleItalic">etc.</span>) is the key to break the pathological circle present in these patients.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ebymar Arismendi, Marina Bantulà, César Picado" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Ebymar" "apellidos" => "Arismendi" ] 1 => array:2 [ "nombre" => "Marina" "apellidos" => "Bantulà" ] 2 => array:2 [ "nombre" => "César" "apellidos" => "Picado" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623000406?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000008/v3_202311210631/S0300289623000406/v3_202311210631/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Lack of Funding for Direct-Acting Oral Anticoagulants for the Treatment of Pulmonary Embolism in Spain: Why and Until When" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "471" "paginaFinal" => "472" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Barca-Hernando, Alberto García-Ortega, Luis Jara-Palomares" "autores" => array:3 [ 0 => array:3 [ "nombre" => "María" "apellidos" => "Barca-Hernando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Alberto" "apellidos" => "García-Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Luis" "apellidos" => "Jara-Palomares" "email" => array:1 [ 0 => "luisoneumo@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Respiratory Department, Hospital Virgen del Rocio, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Venous thromboembolism (VTE), a condition that includes both pulmonary embolism (PE) and deep vein thrombosis (DVT), is the third leading cause of cardiovascular death worldwide after acute coronary syndrome and stroke.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Despite therapeutic advances and being considered as potentially preventable in patients with identified risk factors, it is a public health problem that accounts for more than 20,000 admissions to hospital per year in Spain. A study conducted in 2002 on the total cost burden to Spain of VTE management showed direct and indirect costs of 75.5 million of euros, primarily due to hospital care.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Over the past decade, the availability of direct oral anticoagulants (DOACs) has been a great advance in the management of anticoagulation. Clinical practice guidelines recommend use of DOACs over vitamin K antagonists (VKAs) as anticoagulation therapy for patients with VTE (strong recommendation, moderate-certainty evidence).<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–5</span></a> A meta-analysis involving 24,455 patients with VTE demonstrated that DOACs are non-inferior to VKAs. Recurrent VTE occurred in 2.0% of patients treated with a DOAC compared with 2.2% of patients receiving a VKA (relative risk [RR] 0.88, 95% confidence interval [CI] 0.74–1.05). Additionally, treatment with a DOAC significantly reduced the risk of major bleeding (RR 0.60, 95% CI 0.41–0.88),<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> which is why DOACs should be the preferred choice for the vast majority of patients with VTE.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The advantages of DOACs over VKAs are: rapid onset and offset of action, predictable anticoagulant effect (dose-dependent), no need for routine laboratory monitoring for dose adjustment, few drug interactions, no need to adjust diet and wide therapeutic margin. In fact, these drugs result in cost savings for the National Health System (SNS) since DOACs drastically reduce the need for testing as well as for medical attention for anticoagulant-related bleeding, including fewer A&E attendances and emergency admissions. Furthermore, DOACs help patients to be more independent, which improves the quality of life for patients and caregivers.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, in some clinical situations DOACs are contraindicated: triple positive antiphospholipid syndrome, renal impairment with creatinine clearance<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mL/min (apixaban, edoxaban, and rivaroxaban) or <30<span class="elsevierStyleHsp" style=""></span>mL/min (dabigatran), drug-drug interactions (inhibitors/inducers of P-glycoprotein and cytochrome P450 3A4 [CYP3A4]), malabsorption or thrombocytopenia.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> In addition, none of these drugs have been tested for use in children, pregnancy or breastfeeding.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The main drawback for use of DOACs in Spain is reimbursement. Still, there are a number of ways in which this challenge could be overcome, including price negotiation, pooled procurement, competitive tendering, patent pools and expanded use of generics. Despite receiving marketing authorisation from the Regulatory Authorities and proved to be cost-effective, Spain does not currently finance direct oral anticoagulants for the treatment of VTE, so patients must bear the full costs themselves. This failure to reiburse cannot be justified from either a scientific or economic perspective. Moreover, it contributes to inequities with respect to other patients with other diseases such as atrial fibrillation, and when compared to the rest of citizens in the European Union.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The reduction in cost is especially notable in patients with cancer-associated thrombosis (CAT).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The guidelines for the treatment of VTE in cancer patients recommend low molecular weight heparins (LMWHs) or DOACs.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7–9</span></a> The price of LMWHs is 3–4-times that of DOACs (depending of the weight of the patient), and the subcutaneous route of administration is often considered burdensome by patients, possibly leading to poor adherence.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Four randomised controlled trials have proven that DOACs are a safe and effective treatment alternative to LMWHs in patients with CAT.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11–14</span></a> In 2019, a post hoc study from the HOKUSAI-VTE Cancer trial compared edoxaban vs. dalteparin beyond 6 months in patients with CAT. Between 6 and 12 months, recurrent VTE occurred in 1.1% of patients (3/273) in the dalteparin group and in 0.7% of patients (2/294) in the edoxaban group, and major bleeding was slightly higher in edoxaban group (1.7% vs 1.1%, respectively).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> The Caravaggio trial (multinational, randomised, open-label study which tested apixaban versus dalteparin in patients with CAT) showed a lower rate of recurrent VTE (HR 0.63, 95% CI 0.37–1.07; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 for non-inferiority) and major bleeding (HR 0.82, 95% CI 0.40–1.69; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.60) in the apixaban group.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> Mc Bane et al. conducted the ADAM-VTE trial that compared apixaban to a LMWH in 300 cancer patients with VTE. Recurrent VTE was significantly lower in the apixaban group (0.7 vs. 6.3%, respectively, HR 0.26, 95% CI 0.09–0.80; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02) and there was no significant difference in major bleeding between the two arms (0 vs. 1.4%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> The post hoc analysis of the SELECT-D study (multicentre, randomised, and open-label study that tested rivaroxaban versus placebo in patients with CAT) was underpowered to detect a statistically significant reduction in recurrent VTE with extended anticoagulation.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Based on these four studies, Muñoz et al. performed a cost-effectiveness analysis of DOACs (apixaban, edoxaban, and rivaroxaban) vs<span class="elsevierStyleItalic">.</span> LMWHs for the treatment of cancer-associated VTE in Spain. The 12-month cost of DOAC was 1.994€ (apixaban 1.944€, edoxaban 1.968€, rivaroxaban 2.122€) and 2.152€ for LMWH.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Moreover, it is estimated that maintaining low-molecular-weight heparin for a longer period of time, due to the lack of funding for DOACs, would result in an additional cost of more than 30 million euros.</p><p id="par0040" class="elsevierStylePara elsevierViewall">With that in mind, the Spanish Respiratory Society (SEPAR) has repeatedly requested the Health Authority to include coverage of DOACs into the SNS to contribute to improving the health and quality of life of PE patients.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors state that this project has not received any outside funding.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Heit" 1 => "F.A. Spencer" 2 => "R.H. White" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11239-015-1311-6" "Revista" => array:5 [ "tituloSerie" => "J Thromb Thrombolysis" "fecha" => "2016" "volumen" => "41" "paginaInicial" => "3" "paginaFinal" => "14" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Enfermedad Tromboembólica Venosa en España. Grupo Multidisciplinar para el Estudio de la Enfermedad Tromboembólica en España. Sociedad Española de Medicina Interna (SEMI) 2006. ISBN: 978-84-611-1727-7 84-611r-r1727-1." ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.L. Ortel" 1 => "I. Neumann" 2 => "W. Ageno" 3 => "R. Beyth" 4 => "N.P. Clark" 5 => "A. Cuker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/bloodadvances.2020001830" "Revista" => array:5 [ "tituloSerie" => "Blood Adv" "fecha" => "2020" "volumen" => "4" "paginaInicial" => "4693" "paginaFinal" => "4738" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multidisciplinary consensus for the management of pulmonary thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Lobo" 1 => "S. Alonso" 2 => "J. Arenas" 3 => "P. Domènech" 4 => "P. Escribano" 5 => "C. Fernández-Capitán" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2021.01.038" "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2022" "volumen" => "58" "paginaInicial" => "T246" "paginaFinal" => "T254" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Stevens" 1 => "S.C. Woller" 2 => "L.B. Kreuziger" 3 => "H. Bounameaux" 4 => "K. Doerschug" 5 => "G.J. Geersing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2021.07.055" "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2021" "volumen" => "160" "paginaInicial" => "e545" "paginaFinal" => "e608" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Van der Hulle" 1 => "J. Kooiman" 2 => "P.L. den Exter" 3 => "O.M. Dekkers" 4 => "F.A. Klok" 5 => "M.V. Huisman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.12485" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "320" "paginaFinal" => "328" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Farge" 1 => "C. Frere" 2 => "J.M. Connors" 3 => "C. Ay" 4 => "A.A. Khorana" 5 => "A. Munoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(19)30336-5" "Revista" => array:5 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2019" "volumen" => "20" "paginaInicial" => "e566" "paginaFinal" => "e581" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.S. Key" 1 => "A.A. Khorana" 2 => "N.M. Kuderer" 3 => "K. Bohlke" 4 => "A.Y.Y. Lee" 5 => "J.I. Arcelus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.19.01461" "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2020" "volumen" => "38" "paginaInicial" => "496" "paginaFinal" => "520" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.H. Lyman" 1 => "M. Carrier" 2 => "C. Ay" 3 => "M. Di Nisio" 4 => "L.K. Hicks" 5 => "A.A. Khorana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/BLOODADVANCES.2020003442" "Revista" => array:5 [ "tituloSerie" => "Blood Adv" "fecha" => "2021" "volumen" => "5" "paginaInicial" => "927" "paginaFinal" => "974" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer-associated thrombosis, low-molecular-weight heparin, and the patient experience: a qualitative study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Seaman" 1 => "A. Nelson" 2 => "S. Noble" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/PPA.S58595" "Revista" => array:5 [ "tituloSerie" => "Patient Prefer Adherence" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "453" "paginaFinal" => "461" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended treatment with edoxaban in cancer patients with venous thromboembolism: a post-hoc analysis of the Hokusai-VTE Cancer study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Di Nisio" 1 => "N. van Es" 2 => "M. Carrier" 3 => "T.F. Wang" 4 => "D. Garcia" 5 => "A. Segers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.14561" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2019" "volumen" => "17" "paginaInicial" => "1866" "paginaFinal" => "1874" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apixaban for the treatment of venous thromboembolism associated with cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Agnelli" 1 => "C. Becattini" 2 => "G. Meyer" 3 => "A. Muñoz" 4 => "M.V. Huisman" 5 => "J.M. Connors" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1915103" "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2020" "volumen" => "382" "paginaInicial" => "1599" "paginaFinal" => "1607" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apixaban and dalteparin in active malignancy-associated venous thromboembolism: the ADAM VTE trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.D. McBane" 1 => "W.E. Wysokinski" 2 => "J.G. Le-Rademacher" 3 => "T. Zemla" 4 => "A. Ashrani" 5 => "A. Tafur" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.14662" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2020" "volumen" => "18" "paginaInicial" => "411" "paginaFinal" => "421" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of cancer-associated venous thromboembolism: 12-month outcomes of the placebo versus rivaroxaban randomization of the SELECT-D Trial (SELECT-D: 12m)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Marshall" 1 => "M. Levine" 2 => "C. Hill" 3 => "D. Hale" 4 => "J. Thirlwall" 5 => "V. Wilkie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.14752" "Revista" => array:5 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2020" "volumen" => "18" "paginaInicial" => "905" "paginaFinal" => "915" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness of direct oral anticoagulants compared to low-molecular-weight-heparins for treatment of cancer associated venous thromboembolism in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Muñoz" 1 => "E. Gallardo" 2 => "G. Agnelli" 3 => "C. Crespo" 4 => "M. Forghani" 5 => "D. Arumi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/13696998.2022.2087998" "Revista" => array:5 [ "tituloSerie" => "J Med Econ" "fecha" => "2022" "volumen" => "25" "paginaInicial" => "840" "paginaFinal" => "847" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005900000008/v3_202311210631/S0300289623000236/v3_202311210631/en/main.assets" "Apartado" => array:4 [ "identificador" => "93561" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005900000008/v3_202311210631/S0300289623000236/v3_202311210631/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623000236?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 83 | 22 | 105 |
| 2024 September | 90 | 11 | 101 |
| 2024 August | 113 | 38 | 151 |
| 2024 July | 78 | 14 | 92 |
| 2024 June | 75 | 29 | 104 |
| 2024 May | 99 | 24 | 123 |
| 2024 April | 51 | 17 | 68 |
| 2024 March | 57 | 12 | 69 |
| 2024 February | 93 | 34 | 127 |
| 2024 January | 73 | 24 | 97 |
| 2023 December | 86 | 18 | 104 |
| 2023 November | 85 | 33 | 118 |
| 2023 October | 160 | 39 | 199 |
| 2023 September | 317 | 54 | 371 |
| 2023 August | 580 | 130 | 710 |
| 2023 July | 256 | 49 | 305 |
| 2023 June | 31 | 13 | 44 |
| 2023 May | 34 | 22 | 56 |
| 2023 April | 43 | 18 | 61 |
| 2023 March | 64 | 28 | 92 |
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