Statistics

 array:25 [
  "pii" => "S2174204916301532"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2016.03.010"
  "estado" => "S300"
  "fechaPublicacion" => "2016-11-01"
  "aid" => "857"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Rev Port Cardiol. 2016;35:619.e1-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4238
    "formatos" => array:3 [
      "EPUB" => 238
      "HTML" => 3380
      "PDF" => 620
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S0870255116301482"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2016.03.008"
      "estado" => "S300"
      "fechaPublicacion" => "2016-11-01"
      "aid" => "857"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Rev Port Cardiol. 2016;35:619.e1-5"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8413
        "formatos" => array:3 [
          "EPUB" => 240
          "HTML" => 7279
          "PDF" => 894
        ]
      ]
      "pt" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso Cl&#237;nico</span>"
        "titulo" => "Hipersensibilidade &#224; aspirina e coronariografia urgente&#58; desafio terap&#234;utico"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => array:2 [
          0 => "pt"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "619&#46;e1"
            "paginaFinal" => "619&#46;e5"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Hypersensitivity to aspirin and urgent percutaneous coronary intervention&#58; A therapeutic challenge"
          ]
        ]
        "contieneResumen" => array:2 [
          "pt" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 2021
                "Ancho" => 2333
                "Tamanyo" => 247572
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Algoritmo de decis&#227;o&#58; doentes com DAC e hipersensibilidade &#224; AAS &#40;adaptado do <span class="elsevierStyleItalic">Aspirin Sensitivity&#58; implications for patients with coronary artery disease</span>&#59; JAMA&#59; 2004&#59; Vol 292&#59; No&#46;24&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Tatiana Duarte, Sara Gon&#231;alves, Catarina S&#225;, Rita Marinheiro, Rita Rodrigues, Filipe Seixo, Elza Tomas, Rui Caria"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "Tatiana"
                "apellidos" => "Duarte"
              ]
              1 => array:2 [
                "nombre" => "Sara"
                "apellidos" => "Gon&#231;alves"
              ]
              2 => array:2 [
                "nombre" => "Catarina"
                "apellidos" => "S&#225;"
              ]
              3 => array:2 [
                "nombre" => "Rita"
                "apellidos" => "Marinheiro"
              ]
              4 => array:2 [
                "nombre" => "Rita"
                "apellidos" => "Rodrigues"
              ]
              5 => array:2 [
                "nombre" => "Filipe"
                "apellidos" => "Seixo"
              ]
              6 => array:2 [
                "nombre" => "Elza"
                "apellidos" => "Tomas"
              ]
              7 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Caria"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204916301532"
          "doi" => "10.1016/j.repce.2016.03.010"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301532?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301482?idApp=UINPBA00004E"
      "url" => "/08702551/0000003500000011/v1_201610280519/S0870255116301482/v1_201610280519/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204916302057"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.10.007"
    "estado" => "S300"
    "fechaPublicacion" => "2016-11-01"
    "aid" => "876"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2016;35:621&#46;e1-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3319
      "formatos" => array:3 [
        "EPUB" => 202
        "HTML" => 2565
        "PDF" => 552
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Mitral valve aneurysm&#58; A serious complication of aortic valve endocarditis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "621&#46;e1"
          "paginaFinal" => "621&#46;e5"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Aneurisma da v&#225;lvula mitral&#58; uma complica&#231;&#227;o grave da endocardite valvular a&#243;rtica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 576
              "Ancho" => 1614
              "Tamanyo" => 136921
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram &#40;3-chamber view&#41;&#46; &#40;A&#41; Ruptured aneurysm of the anterior mitral valve leaflet&#46; The long arrow points to the entry site and the small arrow points to the exit site of the aneurysm&#59; &#40;B&#41; color Doppler image showing two mitral regurgitation jets&#58; a small jet through the leaflet coaptation point &#40;small arrow&#41; and a much more significant one through the aneurysm &#40;long arrow&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Maria Jo&#227;o Sousa, Vasco Alves, Sofia Cabral, Nuno Antunes, Lu&#237;s Sousa Pereira, Filomena Oliveira, Jo&#227;o Silveira, Severo Torres"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Maria Jo&#227;o"
              "apellidos" => "Sousa"
            ]
            1 => array:2 [
              "nombre" => "Vasco"
              "apellidos" => "Alves"
            ]
            2 => array:2 [
              "nombre" => "Sofia"
              "apellidos" => "Cabral"
            ]
            3 => array:2 [
              "nombre" => "Nuno"
              "apellidos" => "Antunes"
            ]
            4 => array:2 [
              "nombre" => "Lu&#237;s Sousa"
              "apellidos" => "Pereira"
            ]
            5 => array:2 [
              "nombre" => "Filomena"
              "apellidos" => "Oliveira"
            ]
            6 => array:2 [
              "nombre" => "Jo&#227;o"
              "apellidos" => "Silveira"
            ]
            7 => array:2 [
              "nombre" => "Severo"
              "apellidos" => "Torres"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255116301871"
        "doi" => "10.1016/j.repc.2016.02.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301871?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302057?idApp=UINPBA00004E"
    "url" => "/21742049/0000003500000011/v1_201611160155/S2174204916302057/v1_201611160155/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204916302069"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.10.008"
    "estado" => "S300"
    "fechaPublicacion" => "2016-11-01"
    "aid" => "875"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2016;35:617&#46;e1-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3064
      "formatos" => array:3 [
        "EPUB" => 199
        "HTML" => 2474
        "PDF" => 391
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage&#58; Synergy of two procedures in one percutaneous intervention"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "617&#46;e1"
          "paginaFinal" => "617&#46;e7"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Valvuloplastia mitral percut&#226;nea por bal&#227;o e encerramento do ap&#234;ndice auricular esquerdo&#46; Sinergia de dois procedimentos numa &#250;nica interven&#231;&#227;o percut&#226;nea"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0040"
          "etiqueta" => "Figure 8"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr8.jpeg"
              "Alto" => 676
              "Ancho" => 2050
              "Tamanyo" => 228592
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Fluoroscopic images of release of the Amplatzer Cardiac Plug by the left atrial appendage&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Daniele Gemma, Ra&#250;l Moreno G&#243;mez, Jaime Fern&#225;ndez de Bobadilla, Guillermo Galeote Garc&#237;a, Teresa L&#243;pez Fernandez, Jose R&#46; L&#243;pez-M&#237;nguez, Jos&#233; L&#46; L&#243;pez-Send&#243;n"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Daniele"
              "apellidos" => "Gemma"
            ]
            1 => array:2 [
              "nombre" => "Ra&#250;l"
              "apellidos" => "Moreno G&#243;mez"
            ]
            2 => array:2 [
              "nombre" => "Jaime"
              "apellidos" => "Fern&#225;ndez de Bobadilla"
            ]
            3 => array:2 [
              "nombre" => "Guillermo"
              "apellidos" => "Galeote Garc&#237;a"
            ]
            4 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "L&#243;pez Fernandez"
            ]
            5 => array:2 [
              "nombre" => "Jose R&#46;"
              "apellidos" => "L&#243;pez-M&#237;nguez"
            ]
            6 => array:2 [
              "nombre" => "Jos&#233; L&#46;"
              "apellidos" => "L&#243;pez-Send&#243;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S087025511630186X"
        "doi" => "10.1016/j.repc.2016.01.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511630186X?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302069?idApp=UINPBA00004E"
    "url" => "/21742049/0000003500000011/v1_201611160155/S2174204916302069/v1_201611160155/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Hypersensitivity to aspirin and urgent percutaneous coronary intervention&#58; A therapeutic challenge"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "619&#46;e1"
        "paginaFinal" => "619&#46;e5"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Tatiana Duarte, Sara Gon&#231;alves, Catarina S&#225;, Rita Marinheiro, Rita Rodrigues, Filipe Seixo, Elza Tomas, Rui Caria"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Tatiana"
            "apellidos" => "Duarte"
            "email" => array:1 [
              0 => "taty&#95;isabel&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Sara"
            "apellidos" => "Gon&#231;alves"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Catarina"
            "apellidos" => "S&#225;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Rita"
            "apellidos" => "Marinheiro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Rita"
            "apellidos" => "Rodrigues"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Filipe"
            "apellidos" => "Seixo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Elza"
            "apellidos" => "Tomas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Rui"
            "apellidos" => "Caria"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servi&#231;o de Cardiologia&#44; Centro Hospitalar de Set&#250;bal&#44; Set&#250;bal&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servi&#231;o de Imunoalergologia&#44; Centro Hospitalar de Set&#250;bal&#44; Set&#250;bal&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Hipersensibilidade &#224; aspirina e coronariografia urgente&#58; desafio terap&#234;utico"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2028
            "Ancho" => 2340
            "Tamanyo" => 231716
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Decision algorithm for patients with coronary artery disease and NSAID sensitivity&#46; CAD&#58; coronary artery disease&#46; Adapted from Gollapudi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0060" class="elsevierStylePara elsevierViewall">Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs &#40;NSAIDs&#41; are common in the general population&#44; accounting for 21-25&#37; of adverse drug reactions&#44; of which 0&#46;5-1&#46;9&#37; are due to aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the past&#44; these reactions were related to aspirin&#44; which for decades was the only NSAID available on the market&#44; but most are now observed with other drugs in this class&#44; and so hypersensitivity to NSAIDs is now the preferred term&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Hypersensitive reactions to NSAIDs are classified based on clinical manifestation&#44; the presence of an underlying disease&#44; and cross-reactivity with other cyclooxygenase &#40;COX&#41;-1 inhibitors&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The Position Paper on NSAIDs Hypersensitivity published by the European Academy of Allergy and Clinical Immunology Task Force in 2013 defines five types of reaction<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">NSAIDs-exacerbated respiratory disease</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">NSAIDs-exacerbated cutaneous disease</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">NSAIDs-induced urticaria&#47;angioedema</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Urticaria&#47;angioedema or anaphylaxis induced by a single NSAID or by several NSAIDs belonging to the same chemical group</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Delayed reactions to a single NSAID or to several NSAIDS belonging to the same chemical group&#46;</p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">The first three types are associated with COX-1 inhibition and subsequent activation of mast cells and eosinophils&#44; and are found with various NSAID chemical classes&#46; The putative immunological mechanism of type 4 is immunoglobulin E-mediated&#44; while type 5 is mediated by hypersensitivity at the cellular level&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Dual antiplatelet therapy with aspirin and ticagrelor&#44; prasugrel or clopidogrel is a class I recommendation&#44; level of evidence A&#44; in treating acute coronary syndrome &#40;ACS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The prevalence of aspirin hypersensitivity in patients with myocardial infarction &#40;MI&#41; is unclear but has been estimated at 1&#46;5&#37;&#44; and so antiplatelet therapy in these patients is a challenge&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">One treatment option is desensitization&#44; in which progressively higher oral doses of aspirin are administered until the therapeutic dose is reached in order to increase tolerance&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Patients with type 1 or 3 hypersensitivity reactions can undergo a desensitization protocol&#44; which has been shown to be safe and effective&#46; The procedure is controversial for type 2 reactions and there are no data for type 4 reactions&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">There are currently various desensitization protocols&#44; but guidelines on their use are not supported by randomized trials &#40;level of evidence B or C&#41;&#44; and there have been few studies on patients with ACS&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;5</span></a> The protocol of Wong et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; is the most widely used in the context of unstable coronary artery disease &#40;CAD&#41;&#44; since it enables rapid desensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The following reactions can occur during the desensitization protocol&#58; bronchospasm&#44; &#8805;20&#37; reduction in forced expiratory volume in 1 s&#44; and naso-ocular &#40;lachrymation&#44; peri-orbital edema&#44; rhinorrhea and nasal congestion&#41; and cutaneous symptoms&#46; In the presence of a reaction&#44; directed therapy should be begun and the protocol should be maintained or discontinued depending on response and clinical severity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Patients must continue to take aspirin on a daily basis after successful desensitization in order to prevent resensitization given that the refractory period lasts from 2 to 5 days&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">According to the few studies in the literature&#44; in emergent or urgent situations &#40;ST-elevation ACS or non-ST-elevation ACS with high risk criteria &#91;refractory angina&#44; heart failure or cardiogenic shock&#44; ventricular arrhythmias&#44; and symptomatic or silent dynamic ST-segment or T-wave alterations&#93;&#41; in which desensitization is not possible before percutaneous coronary intervention &#40;PCI&#41;&#44; the suggested therapeutic options include direct thrombin and glycoprotein IIb&#47;IIIa inhibitors during the procedure&#44; even with the use of stents &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">In order to minimize the duration of dual antiplatelet therapy&#44; balloon angioplasty or bare-metal stents &#40;BMS&#41; are the best treatment options for PCI&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The WARIS II trial found that warfarin was superior to aspirin in preventing the combined endpoint of death&#44; nonfatal reinfarction and stroke&#44; although it was associated with more bleeding complications&#59; warfarin is thus an option in the acute phase and for long-term therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case report</span><p id="par0160" class="elsevierStylePara elsevierViewall">AS&#44; a 78-year-old man&#44; an ex-smoker&#44; had a history of hypertension&#44; dyslipidemia&#44; hyperuricemia&#44; benign prostatic hypertrophy&#44; peptic disease&#44; nasal polyposis and asthma&#44; under bronchodilator therapy&#46; He also had a documented history of hypersensitivity reactions to NSAIDs&#44; notably aspirin&#44; following a positive provocation test with naso-ocular symptoms and wheezing at a cumulative aspirin dose of 460 mg&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">He had been asymptomatic until one week before admission&#44; when he began suffering episodes of angina &#40;Canadian Cardiovascular Society class II&#41; and consulted his family doctor&#46; He was referred for exercise testing&#44; which was positive for ischemia&#44; with severe clinical &#40;angina&#41; and electrocardiographic criteria &#40;2&#46;2 mm ST elevation in the inferior leads&#41; after six minutes&#46; The patient experienced symptom relief after the test was terminated and sublingual nitroglycerin was administered&#44; with normalization of the electrocardiogram &#40;ECG&#41; after five minutes&#46; In the light of the exercise test result&#44; he was immediately transferred to the emergency department&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">At admission he was asymptomatic&#44; with no relevant findings on physical examination&#46; Laboratory tests revealed positive biomarkers of myocardial necrosis &#40;troponin I 1&#46;65 &#956;g&#47;l &#91;cut-off 0&#46;04 &#956;g&#47;dl&#93;&#41; and the ECG showed sinus rhythm with a heart rate &#40;HR&#41; of 70 bpm&#44; with no Q waves or ST-segment alterations&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A diagnosis of non-ST elevation MI was made with indication for coronary angiography during hospitalization&#44; after aspirin desensitization&#46; The patient presented a GRACE score of 125 &#40;intermediate risk&#41; at admission&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Anti-ischemia and antiplatelet therapy with ticagrelor was begun&#44; as well as anticoagulation with fondaparinux&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">On the following day&#44; he suffered a recurrence of angina at rest&#44; which was not relieved by sublingual nitroglycerin&#44; only by intravenous isosorbide dinitrate&#46; The ECG showed HR of 60 bpm&#44; sinus rhythm&#44; new-onset Q waves and deep negative T waves in the inferior leads &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#44; while transthoracic echocardiography revealed inferior wall akinesia and preserved biventricular function&#44; with no significant valve changes&#44; and laboratory tests showed elevated biomarkers of myocardial necrosis &#40;peak troponin I 5 &#956;g&#47;l&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">In the light of the patient&#39;s worsening clinical condition and of the changes on diagnostic exams&#44; urgent invasive treatment was considered necessary&#44; and an aspirin desensitization protocol was immediately begun&#46; This consisted of oral administration of increasing doses at intervals of 15 min of 100 mg of aspirin in 100 ml of 0&#46;9&#37; saline solution&#44; resulting in a cumulative dose of 323&#46;4 mg aspirin&#44; in accordance with <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> preceded by pre-treatment with an antihistamine &#40;hydroxyzine 25 mg&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The patient remained in the coronary care unit in the cardiology department during the protocol&#44; under constant electrocardiographic and blood pressuring monitoring by medical and nursing staff&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Desensitization was performed without complications and the patient underwent coronary angiography two hours later&#46; This revealed a 90&#37; lesion in the proximal segment of the circumflex artery &#40;Cx&#41; and an extensive lesion in the proximal segment of the right coronary artery &#40;RCA&#41;&#44; causing severe subocclusive stenosis&#44; with TIMI 3 flow&#46; Angioplasty of the proximal RCA was performed with placement of two BMS and of the proximal Cx with one BMS &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">Anticoagulation was discontinued after the procedure and dual antiplatelet therapy with aspirin and ticagrelor was begun&#46; Hospital stay was uneventful&#44; with no angina or symptoms of aspirin resensitization&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The patient was discharged on the fifth day&#44; under dual antiplatelet therapy &#40;aspirin 100 mg and ticagrelor 90 mg&#44; twice daily&#41; and referred to the angioplasty clinic and the immunology and allergy clinic&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The patient remains under dual antiplatelet therapy with aspirin and ticagrelor after six months of follow-up&#44; and has shown no signs of resensitization to date&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0220" class="elsevierStylePara elsevierViewall">In the case presented&#44; the patient&#39;s worsening clinical condition meant that urgent coronary angiography was indicated&#44; as well as dual antiplatelet therapy&#46; His history of nasal polyposis&#44; rhinitis and aspirin-associated bronchospasm suggested NSAIDs-exacerbated respiratory disease&#44; a situation in which desensitization can be performed&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Although there were therapeutic alternatives&#44; notably warfarin&#44; in view of the need for urgent invasive intervention and the positive experience reported by others using desensitization in this context&#44; it was decided to opt for aspirin desensitization&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">There are various desensitization protocols available but some take more than 24 hours and are therefore not suitable in cases of unstable CAD&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The protocol of Wong et al&#46; was chosen for its speed&#44; enabling coronary angiography to be performed after approximately two hours&#46; According to the literature&#44; this protocol has a low incidence of adverse events and a high rate of success&#44; although most studies have been in patients with aspirin-induced urticaria and angioedema&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">BMS were used in the case presented in order to minimize the risk associated with early discontinuation of dual antiplatelet therapy in view of possible failure of desensitization or the patient discontinuing aspirin therapy during follow-up&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Aspirin desensitization was shown to be safe and effective in our patient&#44; with no complications&#44; as demonstrated by other groups&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The maintenance aspirin dose required to prevent resensitization is unknown&#44; but on the basis of recent studies&#44; a cardioprotective dose of 100 mg in patients taking ticagrelor is sufficient to keep these patients desensitized&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Desensitization in patients with ST-elevation ACS is not indicated since this would delay coronary reperfusion&#46; There have been few studies on such cases&#44; but a loading dose of a thienopyridine and unfractionated heparin have been proposed&#46; The preferred approach is balloon angioplasty or BMS implantation&#44; together with direct thrombin and glycoprotein IIb&#47;IIIa inhibitors&#44; but this is not consensual&#46; We found no mention in our literature review of a periprocedural pharmacological protocol that included antihistamine or corticosteroid therapy&#46; After an invasive procedure&#44; a desensitization protocol should be considered once the patient has stabilized&#46; In most published studies&#44; desensitization was performed within 24 h of PCI&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;7&#44;8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0260" class="elsevierStylePara elsevierViewall">Hypersensitivity to NSAIDs is relatively common and constitutes a therapeutic challenge in patients with CAD&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Aspirin desensitization appears to b-e effective and safe in most CAD patients&#44; as in the case presented&#46; However&#44; more randomized trials are needed to clarify the risks and benefits&#46; At present&#44; its use should be considered on a case-by-case basis&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Desensitization protocols should be established that are appropriate for different situations based on analysis of data from clinical experience&#44; with a view to facilitating decision-making and application&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Protection of human and animal subjects</span><p id="par0275" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Confidentiality of data</span><p id="par0280" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Right to privacy and informed consent</span><p id="par0285" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflicts of interest</span><p id="par0290" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres757429"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec759507"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres757428"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec759508"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-11-10"
    "fechaAceptado" => "2016-03-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec759507"
          "palabras" => array:3 [
            0 => "Acute coronary syndrome"
            1 => "Hypersensitivity to nonsteroidal anti-inflammatory drugs"
            2 => "Desensitization protocols"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec759508"
          "palabras" => array:3 [
            0 => "S&#237;ndrome coron&#225;ria aguda"
            1 => "Hipersensibilidade aos anti-inflamat&#243;rios n&#227;o-esteroides"
            2 => "Protocolos de dessensibiliza&#231;&#227;o"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs are common and five types of reactions have been defined&#46; The prevalence of such reactions in patients with myocardial infarction is unclear&#44; and so antiplatelet therapy in this population is a challenge&#46; Various desensitization protocols have been developed but there are no specific guidelines for their use&#46; The authors present the case of a patient with acute coronary syndrome and aspirin hypersensitivity referred for urgent coronary angiography&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Aspirin desensitization therapy is safe and successful in many patients&#44; but more randomized trials are needed to confirm its benefits in coronary artery disease patients&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">As rea&#231;&#245;es de hipersensibilidade aos anti-inflamat&#243;rios n&#227;o-esteroides s&#227;o comuns na popula&#231;&#227;o em geral&#44; estando definidos cinco tipos de rea&#231;&#245;es&#46; A preval&#234;ncia desta rea&#231;&#227;o adversa em doentes com enfarte agudo do mioc&#225;rdio &#233; incerta&#44; constituindo a antiagrega&#231;&#227;o plaquet&#225;ria um desafio terap&#234;utico nestes doentes&#46; Atualmente existem v&#225;rios protocolos de dessensibiliza&#231;&#227;o&#44; contudo n&#227;o existem orienta&#231;&#245;es espec&#237;ficas para a sua utiliza&#231;&#227;o&#46; Os autores apresentam o caso de um doente com s&#237;ndrome coron&#225;ria aguda e hipersensibilidade &#224; aspirina&#44; com necessidade de coronariografia urgente&#46; A dessensibiliza&#231;&#227;o &#224; aspirina &#233; eficaz e segura na maioria dos doentes&#44; contudo s&#227;o necess&#225;rios mais estudos aleatorizados em doentes com doen&#231;a coron&#225;ria para evidenciar os seus benef&#237;cios&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Duarte T&#44; Gon&#231;alves S&#44; S&#225; C&#44; et al&#46; Hipersensibilidade &#224; aspirina e coronariografia urgente&#58; desafio terap&#234;utico&#46; Rev Port Cardiol&#46; 2016&#59;35&#58;619&#46;e1&#8211;619&#46;e5&#46;</p>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:2 [
        "identificador" => "nom0005"
        "listaDefinicion" => array:1 [
          0 => array:2 [
            "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0025">List of abbreviations</span>"
            "definicion" => array:11 [
              0 => array:2 [
                "termino" => "ACS"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>"
              ]
              1 => array:2 [
                "termino" => "BMS"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">bare-metal stent</p>"
              ]
              2 => array:2 [
                "termino" => "CAD"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">coronary artery disease</p>"
              ]
              3 => array:2 [
                "termino" => "COX"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">cyclooxygenase</p>"
              ]
              4 => array:2 [
                "termino" => "Cx"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">circumflex artery</p>"
              ]
              5 => array:2 [
                "termino" => "ECG"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">electrocardiogram</p>"
              ]
              6 => array:2 [
                "termino" => "HR"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">heart rate</p>"
              ]
              7 => array:2 [
                "termino" => "MI"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">myocardial infarction</p>"
              ]
              8 => array:2 [
                "termino" => "NSAIDs"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">nonsteroidal anti-inflammatory drugs</p>"
              ]
              9 => array:2 [
                "termino" => "PCI"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">percutaneous coronary intervention</p>"
              ]
              10 => array:2 [
                "termino" => "RCA"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">right coronary artery</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2028
            "Ancho" => 2340
            "Tamanyo" => 231716
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Decision algorithm for patients with coronary artery disease and NSAID sensitivity&#46; CAD&#58; coronary artery disease&#46; Adapted from Gollapudi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 778
            "Ancho" => 2340
            "Tamanyo" => 229704
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Electrocardiogram showing sinus rhythm&#44; heart rate 60 bpm&#44; new-onset Q waves and deep negative T waves in the inferior leads&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1181
            "Ancho" => 2257
            "Tamanyo" => 306038
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography&#58; &#40;A&#41; circumflex with 90&#37; lesion in the proximal segment&#59; &#40;B&#41; right coronary with extensive lesion in the proximal segment&#44; causing severe subocclusive stenosis&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time &#40;min&#41;&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">Aspirin dose &#40;mg&#41;&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="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1&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="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&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="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&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="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&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="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&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="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&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="char" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">162&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="char" valign="top">135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">325&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1252290.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Desensitization protocol of Wong et al&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;L&#46; Kowalski"
                            1 => "R&#46; Asero"
                            2 => "S&#46; Bavbek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/all.12260"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy"
                        "fecha" => "2013"
                        "volumen" => "68"
                        "paginaInicial" => "1219"
                        "paginaFinal" => "1232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24117484"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin allergy in patients with myocardial infarction&#58; the allergist&#39;s role"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Kathryn"
                            1 => "M&#46;D&#46; McMullan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2013"
                        "editorial" => "American College of Allergy&#44; Asthma &#38; Immunology&#44; Elsevier"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "General considerations on rapid desensitization for drug hypersensitivity &#8211; a consensus statement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;R&#46; Cernadas"
                            1 => "K&#46; Brockow"
                            2 => "A&#46; Romano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1398-9995.2010.02441.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy"
                        "fecha" => "2010"
                        "volumen" => "65"
                        "paginaInicial" => "1357"
                        "paginaFinal" => "1366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20716314"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin sensitivity&#58; implications for patients with coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;R&#46; Gollapudi"
                            1 => "P&#46;S&#46; Teirstein"
                            2 => "D&#46;D&#46; Stevenson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.292.24.3098"
                      "Revista" => array:4 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2004"
                        "volumen" => "292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15613676"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Approach to &#8220;aspirin allergy&#8221; in cardiovascular patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Ramanuja"
                            1 => "J&#46;A&#46; Breall"
                            2 => "V&#46;G&#46; Kalaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000134306.28561.2A"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2004"
                        "volumen" => "110"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15238467"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;W&#46; Hamm"
                            1 => "J&#46;-P&#46; Bassand"
                            2 => "S&#46; Agewall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehr236"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "2999"
                        "paginaFinal" => "3003"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21873419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspirin hypersensitivity and desensitization protocols&#58; implications for cardiac patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Lambrakis"
                            1 => "G&#46;F&#46; Rushworth"
                            2 => "J&#46; Adamson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2042098611422558"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ther Adv Drug Saf"
                        "fecha" => "2011"
                        "volumen" => "2"
                        "paginaInicial" => "263"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25083218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A strategy for addressing aspirin hypersensitivity in patients requiring urgent PCI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Schiano"
                            1 => "P&#46;G&#46; Steg"
                            2 => "F&#46; Barbou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2048872612441580"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care"
                        "fecha" => "2012"
                        "volumen" => "1"
                        "paginaInicial" => "75"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24062892"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003500000011/v1_201611160155/S2174204916301532/v1_201611160155/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9919"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000011/v1_201611160155/S2174204916301532/v1_201611160155/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301532?idApp=UINPBA00004E"
]