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porcentaje de tiempo durante el que el paciente mantiene una INR dentro del intervalo deseado&#46; Mientras que valores &#60;<span class="elsevierStyleHsp" style=""></span>60&#37; se consideran inefectivos&#44; su incremento se relaciona con una disminuci&#243;n del riesgo de hemorragia y eventos tromb&#243;ticos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los programas de autocontrol del tratamiento con ACO han demostrado un aumento del TRT en ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a>&#46; Presentamos la primera serie pedi&#225;trica en nuestro pa&#237;s que eval&#250;a la implantaci&#243;n de un programa de autocontrol del tratamiento con ACO&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de cohortes retrospectivo entre enero de 2015 y mayo del 2017 en pacientes de edades comprendidas entre 1 y 17 a&#241;os&#46; 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tablas para la auto-dosificaci&#243;n de ACO&#59; plataforma web &#40;TAONet<span class="elsevierStyleSup">&#174;</span>&#41;&#59; y aplicaci&#243;n m&#243;vil &#40;TAONet<span class="elsevierStyleSup">&#174;</span> Me&#41;&#44; que env&#237;a al profesional sanitario informaci&#243;n en tiempo real&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El TRT fue evaluado mediante la f&#243;rmula de Rosendaal&#44; un m&#233;todo de interpolaci&#243;n lineal que reduce el impacto de m&#250;ltiples valores de INR en un periodo corto de tiempo&#46; Siguiendo la metodolog&#237;a de otras series&#44; el TRT se calcul&#243; seg&#250;n la INR diana estricta y ampliando su margen &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2 puntos&#44; puesto que no se suelen realizar cambios de dosis en esos valores<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; El estudio para evaluar la significaci&#243;n estad&#237;stica se realiz&#243; mediante el test de la t de Student para muestras relacionadas tras comprobar la normalidad de la muestra&#46; Se consideraron significativos los resultados con p-valor por debajo de 0&#44;05&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio incluy&#243; 38 pacientes&#44; todos bajo tratamiento con acenocumarol&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> resume los datos de inter&#233;s para nuestra serie&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> recoge los resultados del TRT seg&#250;n la edad&#44; la enfermedad de base y la INR diana&#46; Como complicaciones del tratamiento&#44; una paciente de 15 a&#241;os present&#243; una menorragia durante el periodo de control hospitalario&#46; Ning&#250;n paciente present&#243; eventos tromboemb&#243;licos&#46; Los motivos m&#225;s frecuentes de desviaci&#243;n de la INR fueron los procesos infecciosos &#40;30&#37;&#41; y la no adherencia al tratamiento&#46; Entre los ni&#241;os &#60;<span class="elsevierStyleHsp" style=""></span>5 a&#241;os&#44; los procesos infecciosos justificaron la desviaci&#243;n de la INR en el 71&#37; de las ocasiones&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; el TRT global mejor&#243; significativamente tras la puesta en marcha del programa de autocontrol&#44; alcanzando valores &#62;<span class="elsevierStyleHsp" style=""></span>85&#37; en aquellos ni&#241;os con una INR diana entre 2 y 3&#46; En concreto&#44; los ni&#241;os con derivaci&#243;n cavo-pulmonar total &#40;cirug&#237;a de Fontan&#41; obtuvieron un TRT del 87&#44;7&#37;&#46; Estos resultados son comparables a los publicados por otros grupos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;5</span></a>&#46; Jones et al&#46; describieron un TRT estricto del 69&#44;2&#37; utilizando un programa de autocontrol en 93 pacientes pedi&#225;tricos en tratamiento con warfarina<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46; Otros autores han publicado resultados similares<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&#44; pero ninguno se acerca al 92&#37; del grupo canadiense<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los pacientes de menor edad&#44; en cambio&#44; obtuvieron un TRT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60&#37;&#46; Este resultado se achac&#243; a las variaciones motivadas por infecciones intercurrentes y a que&#44; en su mayor&#237;a &#40;2&#47;3&#41;&#44; los pacientes &#60;<span class="elsevierStyleHsp" style=""></span>5 a&#241;os precisaban de una INR diana m&#225;s elevada&#44; previamente relacionado con un peor control del tratamiento<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;6</span></a>&#46; No obstante&#44; el TRT alcanzado fue significativamente mejor al previo&#44; por lo que el programa de autocontrol se valor&#243; de manera positiva&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Al comparar un mismo grupo de pacientes en 2 momentos diferentes de su evoluci&#243;n no es posible descartar que la mejor&#237;a observada en los resultados pueda deberse a otras causas&#46; Sin embargo&#44; tanto los datos existentes en la literatura<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> como nuestros resultados apoyan la hip&#243;tesis de que el aumento de la frecuencia de la monitorizaci&#243;n y el empoderamiento de los propios pacientes y sus familiares en la capacidad de gesti&#243;n del tratamiento son las probables responsables de los cambios observados&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;31&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;31&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;71&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Femenino &#40;n&#46;&#176;&#47;&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;28&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Enfermedad de Kawasaki &#40;n&#46;&#176;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros &#40;n&#46;&#176;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hospitalario&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">Autocontrol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">General</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">62&#44;20</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;01</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#44;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">78&#44;97</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Rangos edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-4 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">39&#44;62</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;03</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">55&#44;18</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;02</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-12 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">81&#44;50</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;07</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>13-18 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">65&#44;59</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;06</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#44;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">80&#44;49</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;03</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Motivos ACO</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>V&#225;lvula mec&#225;nica mitral &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">68&#44;60</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>V&#225;lvula mec&#225;nica a&#243;rtica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">71&#44;31</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;08</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#44;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">83&#44;24</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cirug&#237;a Fontan &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">87&#44;72</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">61&#44;13</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">78&#44;21</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">INR diana</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#44;5-3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">68&#44;60</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">68&#44;46</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;02</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">85&#44;01</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;004</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Media&#44; DE y significaci&#243;n estad&#237;stica del TRT antes y tras el inicio del programa de autocontrol&#44; calculado para intervalos de INR estricto y ampliado &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2 puntos</p>"
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    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy outcomes of home and hospital warfarin management within a pediatric anticoagulation clinic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Jones"
                            1 => "S&#46; McLoughlin"
                            2 => "D&#46; Piovesan"
                            3 => "H&#46; Savoia"
                            4 => "P&#46; Monagle"
                            5 => "F&#46; Newall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr Hematol Oncol"
                        "fecha" => "2016"
                        "volumen" => "38"
                        "paginaInicial" => "216"
                        "paginaFinal" => "220"
                      ]
                    ]
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            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utility of a dedicated pediatric cardiac anticoagulation program&#58; The Boston Children&#39;s Hospital experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Murray"
                            1 => "A&#46; Hellinger"
                            2 => "R&#46; Dionne"
                            3 => "L&#46; Brown"
                            4 => "R&#46; Galvin"
                            5 => "S&#46; Griggs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Cardiol"
                        "fecha" => "2015"
                        "volumen" => "36"
                        "paginaInicial" => "842"
                        "paginaFinal" => "850"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time in therapeutic range as a marker for thrombotic and bleeding outcomes in Fontan patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Faircloth"
                            1 => "K&#46;M&#46; Miner"
                            2 => "T&#46; Alsaied"
                            3 => "N&#46; Nelson"
                            4 => "J&#46; Ciambarella"
                            5 => "T&#46; Mizuno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thromb Thrombolysis"
                        "fecha" => "2017"
                        "volumen" => "44"
                        "paginaInicial" => "38"
                        "paginaFinal" => "47"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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Carta científica
Programa de autocontrol del tratamiento anticoagulante oral con antagonistas de la vitamina K en pacientes pediátricos
Self-monitoring treatment program with oral vitamin K antagonists in paediatric patients
Rubén Berruecoa,b,d,
Autor para correspondencia
rberrueco@sjdhospitalbarcelona.org

Autor para correspondencia.
, Cristina Benedictob, Anna Ruiz-Llobeta,b, Susanna Gassiota,c, Albert Catalàa,b,d
a Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu (IRP-HSJD), Barcelona, España
b Departamento de Hematología y Oncología Pediátricas, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España
c Laboratorio de Hematología, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España
d Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El aumento de la supervivencia de las cardiopat&#237;as cong&#233;nitas ha conllevado un incremento del uso de anticoagulantes orales &#40;ACO&#41; a largo plazo en la edad pedi&#225;trica<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46; Los m&#225;s utilizados son los antagonistas de la vitamina K&#44; caracterizados por su estrecho margen terap&#233;utico y la necesidad de controles frecuentes de la ratio internacional normalizada &#40;INR&#44; por sus siglas en ingl&#233;s&#41;&#46; Su manejo en ni&#241;os se complica por problemas inherentes a la edad como la ingesta inconsistente o los procesos infecciosos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La calidad del tratamiento se calcula mediante el tiempo en rango terap&#233;utico &#40;TRT&#41;&#44; porcentaje de tiempo durante el que el paciente mantiene una INR dentro del intervalo deseado&#46; Mientras que valores &#60;<span class="elsevierStyleHsp" style=""></span>60&#37; se consideran inefectivos&#44; su incremento se relaciona con una disminuci&#243;n del riesgo de hemorragia y eventos tromb&#243;ticos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los programas de autocontrol del tratamiento con ACO han demostrado un aumento del TRT en ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a>&#46; Presentamos la primera serie pedi&#225;trica en nuestro pa&#237;s que eval&#250;a la implantaci&#243;n de un programa de autocontrol del tratamiento con ACO&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de cohortes retrospectivo entre enero de 2015 y mayo del 2017 en pacientes de edades comprendidas entre 1 y 17 a&#241;os&#46; El objetivo fue comparar el TRT tras implantar un programa de autocontrol con el obtenido durante el a&#241;o anterior&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se recogieron los datos demogr&#225;ficos&#44; la edad&#44; el motivo del tratamiento con ACO&#44; el rango terap&#233;utico diana&#44; los resultados de la INR&#44; la frecuencia de medici&#243;n&#44; la fecha de inicio del autocontrol&#44; la aparici&#243;n de complicaciones tromb&#243;ticas o hemorr&#225;gicas y los motivos que justificaran variaciones de la INR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5 o &#60;<span class="elsevierStyleHsp" style=""></span>1&#44;4&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Tras la aceptaci&#243;n a participar en el estudio&#44; los ni&#241;os y sus cuidadores recibieron formaci&#243;n para el manejo de&#58; dispositivo port&#225;til CoaguChek<span class="elsevierStyleSup">&#174;</span> XS &#40;Roche Diagnostics&#41;&#59; tablas para la auto-dosificaci&#243;n de ACO&#59; plataforma web &#40;TAONet<span class="elsevierStyleSup">&#174;</span>&#41;&#59; y aplicaci&#243;n m&#243;vil &#40;TAONet<span class="elsevierStyleSup">&#174;</span> Me&#41;&#44; que env&#237;a al profesional sanitario informaci&#243;n en tiempo real&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El TRT fue evaluado mediante la f&#243;rmula de Rosendaal&#44; un m&#233;todo de interpolaci&#243;n lineal que reduce el impacto de m&#250;ltiples valores de INR en un periodo corto de tiempo&#46; Siguiendo la metodolog&#237;a de otras series&#44; el TRT se calcul&#243; seg&#250;n la INR diana estricta y ampliando su margen &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2 puntos&#44; puesto que no se suelen realizar cambios de dosis en esos valores<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; El estudio para evaluar la significaci&#243;n estad&#237;stica se realiz&#243; mediante el test de la t de Student para muestras relacionadas tras comprobar la normalidad de la muestra&#46; Se consideraron significativos los resultados con p-valor por debajo de 0&#44;05&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio incluy&#243; 38 pacientes&#44; todos bajo tratamiento con acenocumarol&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> resume los datos de inter&#233;s para nuestra serie&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> recoge los resultados del TRT seg&#250;n la edad&#44; la enfermedad de base y la INR diana&#46; Como complicaciones del tratamiento&#44; una paciente de 15 a&#241;os present&#243; una menorragia durante el periodo de control hospitalario&#46; Ning&#250;n paciente present&#243; eventos tromboemb&#243;licos&#46; Los motivos m&#225;s frecuentes de desviaci&#243;n de la INR fueron los procesos infecciosos &#40;30&#37;&#41; y la no adherencia al tratamiento&#46; Entre los ni&#241;os &#60;<span class="elsevierStyleHsp" style=""></span>5 a&#241;os&#44; los procesos infecciosos justificaron la desviaci&#243;n de la INR en el 71&#37; de las ocasiones&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; el TRT global mejor&#243; significativamente tras la puesta en marcha del programa de autocontrol&#44; alcanzando valores &#62;<span class="elsevierStyleHsp" style=""></span>85&#37; en aquellos ni&#241;os con una INR diana entre 2 y 3&#46; En concreto&#44; los ni&#241;os con derivaci&#243;n cavo-pulmonar total &#40;cirug&#237;a de Fontan&#41; obtuvieron un TRT del 87&#44;7&#37;&#46; Estos resultados son comparables a los publicados por otros grupos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;5</span></a>&#46; Jones et al&#46; describieron un TRT estricto del 69&#44;2&#37; utilizando un programa de autocontrol en 93 pacientes pedi&#225;tricos en tratamiento con warfarina<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46; Otros autores han publicado resultados similares<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&#44; pero ninguno se acerca al 92&#37; del grupo canadiense<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los pacientes de menor edad&#44; en cambio&#44; obtuvieron un TRT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60&#37;&#46; Este resultado se achac&#243; a las variaciones motivadas por infecciones intercurrentes y a que&#44; en su mayor&#237;a &#40;2&#47;3&#41;&#44; los pacientes &#60;<span class="elsevierStyleHsp" style=""></span>5 a&#241;os precisaban de una INR diana m&#225;s elevada&#44; previamente relacionado con un peor control del tratamiento<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;6</span></a>&#46; No obstante&#44; el TRT alcanzado fue significativamente mejor al previo&#44; por lo que el programa de autocontrol se valor&#243; de manera positiva&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Al comparar un mismo grupo de pacientes en 2 momentos diferentes de su evoluci&#243;n no es posible descartar que la mejor&#237;a observada en los resultados pueda deberse a otras causas&#46; Sin embargo&#44; tanto los datos existentes en la literatura<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> como nuestros resultados apoyan la hip&#243;tesis de que el aumento de la frecuencia de la monitorizaci&#243;n y el empoderamiento de los propios pacientes y sus familiares en la capacidad de gesti&#243;n del tratamiento son las probables responsables de los cambios observados&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;28&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">55&#44;18</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">81&#44;50</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;07</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>13-18 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">65&#44;59</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;06</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#44;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">80&#44;49</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;03</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Motivos ACO</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>V&#225;lvula mec&#225;nica mitral &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">68&#44;60</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>V&#225;lvula mec&#225;nica a&#243;rtica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">71&#44;31</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;08</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#44;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">83&#44;24</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">0&#44;004</span>&nbsp;\t\t\t\t\t\t\n
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                0 => "xTab1911596.png"
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Media&#44; DE y significaci&#243;n estad&#237;stica del TRT antes y tras el inicio del programa de autocontrol&#44; calculado para intervalos de INR estricto y ampliado &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2 puntos</p>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy outcomes of home and hospital warfarin management within a pediatric anticoagulation clinic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Jones"
                            1 => "S&#46; McLoughlin"
                            2 => "D&#46; Piovesan"
                            3 => "H&#46; Savoia"
                            4 => "P&#46; Monagle"
                            5 => "F&#46; Newall"
                          ]
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ISSN: 16954033
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Anales de Pediatría