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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">Os doentes com s&#237;ndrome coron&#225;ria aguda &#40;SCA&#41; representam uma popula&#231;&#227;o heterog&#233;nea com diferentes riscos de eventos pelo que a avalia&#231;&#227;o inicial tem um papel principal na defini&#231;&#227;o da estrat&#233;gia terap&#234;utica mais adequada<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a>&#46; O tratamento desses doentes engloba terap&#234;utica antitromb&#243;tica e procedimentos invasivos que condicionam risco acrescido de hemorragia<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">2</span></a>&#44; cuja incid&#234;ncia varia entre 1&#8208;10&#37;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">3</span></a>&#46; A variabilidade da incid&#234;ncia das complica&#231;&#245;es hemorr&#225;gicas &#233; secund&#225;ria a v&#225;rios fatores&#44; incluindo diferen&#231;as nas caracter&#237;sticas dos doentes&#44; terap&#234;uticas concomitantes e diferentes defini&#231;&#245;es de hemorragia usadas<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">3</span></a>&#46; No entanto&#44; independentemente da defini&#231;&#227;o usada&#44; v&#225;rios estudos demonstraram que os eventos hemorr&#225;gicos est&#227;o associados a eventos adversos&#44; tais como morte&#44; enfarte agudo do mioc&#225;rdio &#40;EAM&#41; n&#227;o fatal&#44; acidente vascular cerebral &#40;AVC&#41; e trombose de <span class="elsevierStyleItalic">stent</span><a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o do risco hemorr&#225;gico inclui hist&#243;ria detalhada de sintomas hemorr&#225;gicos&#44; comorbilidades predisponentes&#44; avalia&#231;&#227;o de dados anal&#237;ticos e o uso de um <span class="elsevierStyleItalic">score</span> de risco hemorr&#225;gico<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> CRUSADE<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a> foi desenvolvido numa popula&#231;&#227;o abrangente de doentes com SCA sem eleva&#231;&#227;o de ST para avaliar o risco hemorr&#225;gico e&#44; mais recentemente&#44; foi tamb&#233;m validado no EAM com eleva&#231;&#227;o de ST<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">8</span></a>&#46; Esse <span class="elsevierStyleItalic">score</span> contempla oito vari&#225;veis que incluem caracter&#237;sticas basais&#44; vari&#225;veis cl&#237;nicas e valores laboratoriais na admiss&#227;o<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#46; Atualmente&#44; &#233; o m&#233;todo mais usado para determinar o risco hemorr&#225;gico por ter demonstrado melhor poder discriminat&#243;rio<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">6&#44;9&#44;10</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O uso do <span class="elsevierStyleItalic">score</span> CRUSADE tem como objetivo estratificar os doentes com SCA&#44; permite escolher estrat&#233;gias terap&#234;uticas mais adequadas de modo a reduzir o risco de hemorragia e consequentemente melhorar o progn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Com este estudo&#44; os autores pretendem analisar a aplicabilidade do <span class="elsevierStyleItalic">score</span> CRUSADE nos doentes com SCA&#44; considerando que nos &#250;ltimos 10 anos se verificaram modifica&#231;&#245;es importantes na abordagem e no tratamento desses doentes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Desenho do estudo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudo retrospetivo&#44; descritivo e correlacional do Centro Hospitalar Universit&#225;rio do Algarve com doentes admitidos com o diagn&#243;stico de SCA no servi&#231;o de Cardiologia de 1 de outubro de 2010 a 31 de agosto de 2014&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE foi calculado para cada doente e foi avaliada a capacidade de predi&#231;&#227;o de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar &#40;HMIH&#41;&#46; Foram avaliados os preditores de HMIH&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sele&#231;&#227;o de doentes</span><p id="par0035" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 2818 doentes com o diagn&#243;stico de s&#237;ndrome coron&#225;ria aguda com evolu&#231;&#227;o inferior a 48<span class="elsevierStyleHsp" style=""></span>h&#46; O diagn&#243;stico de EAM foi definido como a presen&#231;a de dor tor&#225;cica ou equivalente anginoso nas &#250;ltimas 48<span class="elsevierStyleHsp" style=""></span>h associada a altera&#231;&#245;es eletrocardiogr&#225;ficas isqu&#233;micas &#40;desvios do segmento ST ou ondas T negativas&#41; e eleva&#231;&#227;o de troponina acima do valor de refer&#234;ncia&#46; O diagn&#243;stico de angina inst&#225;vel foi definido pela presen&#231;a de dor tor&#225;cica ou equivalente anginoso associada ou n&#227;o a altera&#231;&#245;es eletrocardiogr&#225;ficas isqu&#233;micas na aus&#234;ncia de eleva&#231;&#227;o de troponina acima do valor de refer&#234;ncia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Foram exclu&#237;dos os doentes com EAM ap&#243;s procedimentos de revasculariza&#231;&#227;o &#40;EAM tipo 4 e 5&#41; e com EAM tipo 2 &#40;classifica&#231;&#227;o de acordo com a redefini&#231;&#227;o de Enfarte do Mioc&#225;rdio de 2007<span class="elsevierStyleHsp" style=""></span>da Joint ESC&#47;ACCF&#47;AHA&#47;WHF Task Force&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Na an&#225;lise da capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE&#44; dos 2818 doentes foram exclu&#237;dos 203 &#40;7&#44;2&#37;&#41; devido &#224; impossibilidade de calcular o respetivo <span class="elsevierStyleItalic">score&#46;</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Colheita de dados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram colhidos dados demogr&#225;ficos &#40;idade e g&#233;nero&#41;&#44; antecedentes pessoais relevantes &#40;antecedentes de EAM&#44; insufici&#234;ncia card&#237;aca&#44; interven&#231;&#227;o coron&#225;ria percut&#226;nea &#91;ICP&#93;&#44; cirurgia de revasculariza&#231;&#227;o mioc&#225;rdica&#44; hemorragia&#44; angina de peito&#44; doen&#231;a pulmonar obstrutiva cr&#243;nica &#91;DPOC&#93; e neoplasia&#41;&#44; fatores de risco cardiovascular &#40;hipertens&#227;o arterial &#91;HTA&#93;&#44; diabetes&#44; dislipidemia e tabagismo atual&#41;&#46; Foram avaliados dados relacionados com o internamento&#44; nomeadamente dados cl&#237;nicos na admiss&#227;o &#40;press&#227;o arterial sist&#243;lica&#44; frequ&#234;ncia card&#237;aca e hemat&#243;crito&#41;&#44; dados da coronariografia &#40;acesso vascular e feitura de angioplastia&#41;&#44; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda&#44; tipo de SCA &#40;EAM com eleva&#231;&#227;o do segmento ST&#44; EAM sem eleva&#231;&#227;o do segmento ST&#44; EAM de localiza&#231;&#227;o indeterminada e angina inst&#225;vel&#41;&#44; medica&#231;&#227;o administrada &#40;&#225;cido acetilsalic&#237;lico &#91;AAS&#93;&#44; clopidogrel&#44; ticagrelor&#44; enoxaparina&#44; heparina n&#227;o fracionada&#44; fondaparinux&#44; varfarina&#44; inibidor das glicoprote&#237;nas IIb&#47;IIIa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A clearance de creatinina foi estimada com a f&#243;rmula de Cockcroft&#8208;Gault&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A doen&#231;a vascular foi definida por antecedentes de doen&#231;a arterial perif&#233;rica e&#47;ou acidente vascular cerebral&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Mortalidade intra&#8208;hospitalar &#40;MIH&#41; foi definida como morte de qualquer causa ocorrida durante o internamento por SCA&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105"><span class="elsevierStyleItalic">Endpoint</span> do estudo</span><p id="par0070" class="elsevierStylePara elsevierViewall">Os <span class="elsevierStyleItalic">endpoints</span> deste estudo correspondem &#224; avalia&#231;&#227;o da capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE de HMIH e &#224; determina&#231;&#227;o dos preditores independentes de HMIH&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar &#40;HMIH&#41; foi definida segundo a classifica&#231;&#227;o de GUSTO como a ocorr&#234;ncia de hemorragia intracraniana ou hemorragia com compromisso hemodin&#226;mico requerendo interven&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">13</span></a>&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE foi calculado para cada doente atrav&#233;s das oito vari&#225;veis &#40;hemat&#243;crito basal&#44; taxa de filtra&#231;&#227;o glomerular&#44; frequ&#234;ncia card&#237;aca na admiss&#227;o&#44; press&#227;o arterial sist&#243;lica na admiss&#227;o&#44; sinais de insufici&#234;ncia card&#237;aca na admiss&#227;o&#44; g&#233;nero&#44; hist&#243;ria de doen&#231;a vascular e diabetes <span class="elsevierStyleItalic">mellitus</span>&#41;&#46; Foram estabelecidas cinco categorias de risco de hemorragia grave durante o internamento segundo os pontos de corte e intervalos definidos pelos investigadores do CRUSADE<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#44; designadamente muito baixo risco &#40;pontua&#231;&#227;o inferior a 20&#41;&#44; baixo &#40;21 a 30 pontos&#41;&#44; moderado &#40;31 a 40 pontos&#41;&#44; elevado &#40;41 a 50 pontos&#41; e muito elevado &#40;superior a 50&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">An&#225;lise estat&#237;stica</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foi efetuada an&#225;lise descritiva para a caracteriza&#231;&#227;o do perfil amostral&#46; As vari&#225;veis cont&#237;nuas s&#227;o apresentadas como m&#233;dia e desvio padr&#227;o&#46; As vari&#225;veis categ&#243;ricas s&#227;o apresentadas em n&#250;mero &#40;percentagem&#41;&#46; Para cada doente foi calculado o <span class="elsevierStyleItalic">score</span> CRUSADE&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE na nossa popula&#231;&#227;o foi testada por an&#225;lise da &#225;rea abaixo da curva &#40;AUC&#41; <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> &#40;ROC&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">14</span></a> e a calibra&#231;&#227;o do modelo pelo teste de Hosmer&#8208;Lemeshow &#40;H&#8208;L&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">15</span></a>&#46; Com o teste H&#8208;L&#44; um modelo ter&#225; uma calibra&#231;&#227;o adequada se o valor de p n&#227;o for significativo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Para averigua&#231;&#227;o da exist&#234;ncia de associa&#231;&#227;o entre vari&#225;veis de natureza categ&#243;rica aplicou&#8208;se o teste de qui&#8208;quadrado&#44; na presen&#231;a de uma vari&#225;vel cont&#237;nua aplicou&#8208;se o teste <span class="elsevierStyleItalic">t</span> de Student<span class="elsevierStyleItalic">&#46;</span></p><p id="par0095" class="elsevierStylePara elsevierViewall">Para aferi&#231;&#227;o de preditores de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar aplicou&#8208;se uma regress&#227;o log&#237;stica bin&#225;ria&#46; Considerou&#8208;se como n&#237;vel de signific&#226;ncia de 95&#37; com um valor p inferior a 0&#44;05&#46; A an&#225;lise estat&#237;stica foi feita com o <span class="elsevierStyleItalic">software</span> IBM SPSS <span class="elsevierStyleItalic">Statistics</span> &#40;<span class="elsevierStyleItalic">version 20&#46;</span>0&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Caracter&#237;sticas da popula&#231;&#227;o</span><p id="par0100" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas basais da popula&#231;&#227;o do estudo est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 2818 doentes com SCA&#44; 73&#44;9&#37; do g&#233;nero masculino&#44; com idade m&#233;dia de 66 &#177; 13 anos&#46; Na admiss&#227;o hospitalar&#44; os doentes tinham um hemat&#243;crito m&#233;dio de 41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#37;&#44; frequ&#234;ncia card&#237;aca m&#233;dia de 77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 bpm&#44; press&#227;o arterial sist&#243;lica m&#233;dia de 139<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mmHg&#44; taxa de filtra&#231;&#227;o glomerular m&#233;dia de 81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37<span class="elsevierStyleHsp" style=""></span>ml&#47;min e 10&#44;9&#37; apresentavam sinais de insufici&#234;ncia card&#237;aca&#46; O diagn&#243;stico de admiss&#227;o mais frequente foi o EAM sem eleva&#231;&#227;o de ST &#40;48&#44;4&#37;&#41;&#44; seguido do EAM com eleva&#231;&#227;o de ST &#40;44&#44;4&#37;&#41;&#46; Foi feita coronariografia em 75&#44;3&#37; dos doentes&#44; 91&#44;5&#37; atrav&#233;s de acesso vascular radial e 58&#44;3&#37; foram submetidos a angioplastia coron&#225;ria&#46; Relativamente &#224; terap&#234;utica antitromb&#243;tica no internamento&#44; 96&#44;8&#37; dos doentes receberam aspirina&#44; 73&#37; clopidogrel&#44; 2&#44;8&#37; ticagrelor e 47&#44;9&#37; fondaparinux&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Durante o internamento&#44; 113 &#40;4&#44;0&#37;&#41; doentes faleceram e 52 &#40;1&#44;8&#37;&#41; apresentaram HMIH&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Poder discriminat&#243;rio do <span class="elsevierStyleItalic">score</span> CRUSADE</span><p id="par0115" class="elsevierStylePara elsevierViewall">A hemorragia estimada pelo <span class="elsevierStyleItalic">score</span> CRUSADE para a nossa popula&#231;&#227;o foi de 7&#44;1&#37;&#44; valor estatisticamente diferente do que obtivemos &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46; A incid&#234;ncia de HMIH nas diferentes categorias do <span class="elsevierStyleItalic">score</span> CRUSADE foi de 0&#44;5&#37; na de muito baixo risco &#40;taxa estimada pelo <span class="elsevierStyleItalic">score</span> de 3&#44;1&#37;&#41;&#59; 1&#44;5&#37; na de baixo &#40;estimada de 5&#44;5&#37;&#41;&#59; 1&#44;6&#37; na de moderado &#40;estimada de 8&#44;6&#37;&#41;&#59; 5&#44;5&#37; na de elevado &#40;estimada de 11&#44;9&#37;&#41; e 4&#44;4&#37; na de muito elevado &#40;estimada de 19&#44;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; A capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE na nossa popula&#231;&#227;o foi moderada&#44; com uma &#225;rea abaixo da curva ROC de 0&#44;73 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Preditores de hemorragia <span class="elsevierStyleItalic">major</span> durante o internamento</span><p id="par0120" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">endpoint</span> HMIH associou&#8208;se &#224;s seguintes vari&#225;veis&#58; idade mais avan&#231;ada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; HTA &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#44; angina de peito &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; hemorragia pr&#233;via &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; DPOC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#44; neoplasia &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; frequ&#234;ncia card&#237;aca mais elevada na admiss&#227;o &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; menor valor de hemoglobina &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; acesso vascular femoral &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e menor fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda &#40;FEVE&#41; na alta hospitalar &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A HMIH associou&#8208;se a maior mortalidade intra&#8208;hospitalar &#40;15&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;8&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Quando inclu&#237;das em an&#225;lise multivariada todas as associa&#231;&#245;es significativas previamente referidas&#44; a idade mais avan&#231;ada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; o acesso vascular femoral &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; a frequ&#234;ncia card&#237;aca mais elevada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; e a toma de ticagrelor durante o internamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; foram preditores de HMIH &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discuss&#227;o</span><p id="par0130" class="elsevierStylePara elsevierViewall">Na nossa popula&#231;&#227;o contempor&#226;nea de doentes com SCA&#44; o <span class="elsevierStyleItalic">score</span> CRUSADE sobrestimou o risco de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar&#46;</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar</span><p id="par0135" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a taxa de HMIH foi de 1&#44;8&#37;&#46; Na literatura&#44; a incid&#234;ncia de HMIH varia entre 1&#8208;10&#37;&#44; cuja variabilidade &#233; secund&#225;ria a v&#225;rios fatores&#44; como s&#227;o exemplo diferen&#231;as nas caracter&#237;sticas dos doentes&#44; terap&#234;uticas concomitantes e diferentes defini&#231;&#245;es de hemorragia usadas<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A taxa de HMIH obtida foi significativamente inferior &#224; esperado pelo <span class="elsevierStyleItalic">score</span> CRUSADE &#40;7&#44;1&#37;&#41; para a nossa popula&#231;&#227;o &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Quando comparadas as v&#225;rias categorias de risco&#44; verificou&#8208;se que o <span class="elsevierStyleItalic">score</span> CRUSADE sobrestimou a taxa de HMIH em todas as categorias&#46; Observaram&#8208;se maiores diferen&#231;as nas categorias de risco mais elevadas &#40;risco moderado&#44; elevado e muito elevado&#41;&#46; Esses resultados podem ser explicados pela evid&#234;ncia de que a taxa de HMIH nos doentes com SCA tem reduzido ao longo do tempo&#44; apesar do uso de terap&#234;uticas farmacol&#243;gicas e de interven&#231;&#227;o mais agressivas&#46; Fox et al<span class="elsevierStyleItalic">&#46;</span>&#44; entre 2000 e 2007&#44; reportaram uma redu&#231;&#227;o significativa nas taxas de hemorragia de 2&#44;6&#37; para 1&#44;8&#37; nos doentes com SCA &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">16</span></a>&#46; V&#225;rios fatores poder&#227;o ter contribu&#237;do para esses resultados&#44; como s&#227;o exemplo a melhoria da t&#233;cnica da cateteriza&#231;&#227;o card&#237;aca&#44; o uso de cateteres de menor calibre&#44; o uso do acesso vascular radial&#44; melhor sele&#231;&#227;o da terap&#234;utica antitromb&#243;tica ou altera&#231;&#227;o do limiar para transfus&#227;o de concentrado eritrocit&#225;rio<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">16</span></a>&#46; &#201; reconhecido que os doentes com HMIH apresentam pior progn&#243;stico&#44; com maior risco de mortalidade intra&#8208;hospitalar<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; No estudo de Spencer et al<span class="elsevierStyleItalic">&#46;</span>&#44; com 40 087 doentes com SCA&#44; a HMIH associou&#8208;se a maior mortalidade intra&#8208;hospitalar &#40;21&#37; <span class="elsevierStyleItalic">versus</span> 6&#37;&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">17</span></a>&#46; No nosso estudo&#44; a HMIH tamb&#233;m se associou a maior mortalidade &#40;15&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;8&#37;&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A HMIH tem um impacto negativo no progn&#243;stico dos doentes com SCA&#44; &#233; necess&#225;rio implantar estrat&#233;gias para a sua redu&#231;&#227;o&#46; N&#227;o obstante&#44; v&#225;rios preditores de hemorragia s&#227;o tamb&#233;m preditores de eventos isqu&#234;micos&#44; o que dificulta a obten&#231;&#227;o da m&#225;xima efic&#225;cia anti&#8208;isqu&#233;mica com m&#237;nimo risco hemorr&#225;gico<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">7&#44;10</span></a>&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Poder discriminat&#243;rio do <span class="elsevierStyleItalic">score</span> CRUSADE</span><p id="par0145" class="elsevierStylePara elsevierViewall">Na nossa popula&#231;&#227;o&#44; a capacidade preditora do <span class="elsevierStyleItalic">score</span> CRUSADE para HMIH foi aceit&#225;vel&#44; com uma &#225;rea abaixo da curva ROC de 0&#44;73&#46; No entanto&#44; esse resultado n&#227;o &#233; &#243;timo&#46; Abu&#8208;Assi et al<span class="elsevierStyleItalic">&#46;</span> avaliaram a performance do <span class="elsevierStyleItalic">score</span> CRUSADE numa coorte de 4500 doentes com SCA e objetivaram um poder discriminat&#243;rio de 0&#44;80 na predi&#231;&#227;o de hemorragia <span class="elsevierStyleItalic">major</span><a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#46; Similarmente&#44; Manzano&#8208;Fern&#225;ndez et al<span class="elsevierStyleItalic">&#46;</span> em 1587 doentes com SCA relataram um poder discriminat&#243;rio de 0&#44;79<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a>&#46; Contrariamente&#44; outras s&#233;ries reportaram um pior poder discriminat&#243;rio&#46; Ariza&#8208;Sol&#233; et al<span class="elsevierStyleItalic">&#46;</span>&#44; em 1976 doentes com SCA&#44; determinaram um poder discriminat&#243;rio de 0&#44;70<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">18</span></a>&#46; Amador et al<span class="elsevierStyleItalic">&#46;</span>&#44; em 516 doentes com SCA sem eleva&#231;&#227;o de ST&#44; objetivaram uma AUC de 0&#44;61<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">19</span></a>&#46; Em determinados subgrupos de popula&#231;&#245;es&#44; como s&#227;o exemplo os doentes com idade superior a 75 anos&#44; os que n&#227;o fizeram coronariografia e os anticoagulados previamente&#44; foi demonstrado que o <span class="elsevierStyleItalic">score</span> CRUSADE tem uma capacidade preditiva muito modesta com AUC inferiores a 0&#44;70<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">9&#44;20&#44;21</span></a>&#46; Na verdade&#44; relativamente aos doentes sob estrat&#233;gia conservadora&#44; o desempenho do CRUSADE foi modesto na popula&#231;&#227;o na qual foi desenvolvido o <span class="elsevierStyleItalic">score</span>&#44; com uma AUC de 0&#44;68<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#46; Desse modo&#44; verifica&#8208;se uma importante heterogeneidade no poder discriminat&#243;rio do <span class="elsevierStyleItalic">score</span> CRUSADE nos doentes com SCA&#46; V&#225;rios fatores podem contribuir para essas diferen&#231;as e dificultar a avalia&#231;&#227;o do risco hemorr&#225;gico&#44; como s&#227;o exemplo a idade&#44; as comorbilidades&#44; a terap&#234;utica antitromb&#243;tica institu&#237;da&#44; a estrat&#233;gia escolhida &#40;invasiva ou conservadora&#41; ou o acesso vascular da coronariografia&#46; &#201; necess&#225;rio desenvolver um <span class="elsevierStyleItalic">score</span> adequado &#224; pr&#225;tica cl&#237;nica atual que permita a correta&#44; personalizada e acess&#237;vel estratifica&#231;&#227;o dos doentes com SCA&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Preditores de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar</span><p id="par0150" class="elsevierStylePara elsevierViewall">No nosso estudo determin&#225;mos como preditores independentes de HMIH a idade mais avan&#231;ada&#44; a frequ&#234;ncia card&#237;aca mais elevada na admiss&#227;o&#44; o acesso vascular via femoral e a toma de ticagrelor durante o internamento&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Como referido previamente&#44; os doentes com SCA s&#227;o heterog&#233;neos o que condiciona a determina&#231;&#227;o de diferentes preditores em diferentes popula&#231;&#245;es de doentes&#46; O estudo de Mehran et al<span class="elsevierStyleItalic">&#46;</span> com 17421 doentes com SCA determinou sete preditores de hemorragia&#44; nomeadamente g&#233;nero feminino&#44; idade avan&#231;ada&#44; creatinina s&#233;rica elevada&#44; contagem de leuc&#243;citos&#44; anemia e uso de heparina n&#227;o fracionada com inibidor GP IIb&#47;IIIa<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">22</span></a>&#46; Moscucci et al<span class="elsevierStyleItalic">&#46;</span>&#44; no registo GRACE com 24&#46;045 doentes com SCA&#44; identificaram como preditores g&#233;nero feminino&#44; idade avan&#231;ada&#44; insufici&#234;ncia renal e hist&#243;ria pr&#233;via de hemorragia<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">23</span></a>&#46; Nikolsky et al<span class="elsevierStyleItalic">&#46;</span>&#44; al&#233;m da idade&#44; do g&#233;nero feminino e da insufici&#234;ncia renal&#44; determinaram a anemia pr&#233;&#8208;existente&#44; administra&#231;&#227;o de heparina de baixo peso molecular nas 48<span class="elsevierStyleHsp" style=""></span>h antes da ICP e o uso de bal&#227;o intra&#8208;a&#243;rtico como preditores de hemorragia<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">24</span></a>&#46; Apesar de as diferen&#231;as na incid&#234;ncia e na defini&#231;&#227;o de hemorragia entre os estudos&#44; a idade&#44; o g&#233;nero feminino e a insufici&#234;ncia renal s&#227;o vari&#225;veis frequentemente identificadas<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">2&#44;22&#44;23</span></a>&#46; No nosso estudo&#44; o ticagrelor foi preditor de HMIH&#46; Esse resultado tem de ser interpretado no contexto de que apenas 2&#44;8&#37; dos doentes tomaram esse f&#225;rmaco&#46; No estudo PLATO<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">25</span></a>&#44; a toma de ticagrelor demonstrou reduzir a mortalidade cerebrovascular e cardiovascular&#44; o EAM e o AVC&#44; mas associou&#8208;se a maior taxa de hemorragia <span class="elsevierStyleItalic">major</span> n&#227;o relacionada com cirurgia de revasculariza&#231;&#227;o mioc&#225;rdica comparativamente ao clopidogrel &#40;4&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; <a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">25</span></a>&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Acesso vascular da coronariografia</span><p id="par0160" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; 91&#44;5&#37; dos doentes fizeram coronariografia por acesso vascular radial&#44; valor que &#233; superior a outras s&#233;ries publicadas que avaliaram a aplicabilidade do CRUSADE e que reportaram taxas entre 64&#8208;83&#44;1&#37;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">1&#44;9&#44;18&#44;26</span></a>&#46; Na an&#225;lise multivariada&#44; o acesso vascular femoral foi preditor independente de HMIH &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; resultado que est&#225; de acordo com a evid&#234;ncia cl&#237;nica mais recente<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; No entanto&#44; importa salientar que esse resultado tem de ser interpretado no contexto de que apenas 8&#44;5&#37; dos doentes fizeram coronariografia por acesso vascular femoral&#46; Nos doentes submetidos a ICP&#44; a hemorragia <span class="elsevierStyleItalic">major</span> periprocedimento &#233; uma complica&#231;&#227;o poss&#237;vel com incid&#234;ncia de 1&#44;7&#8208;3&#44;5&#37; nas s&#233;ries mais contempor&#226;neas<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">29&#8211;31</span></a>&#46; V&#225;rias s&#233;ries mostraram que o acesso vascular radial est&#225; associado a menor taxa de complica&#231;&#245;es hemorr&#225;gicas periprocedimento comparativamente ao acesso femoral<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">32&#8211;35</span></a>&#46; O estudo RIVAL reportou redu&#231;&#227;o das complica&#231;&#245;es vasculares <span class="elsevierStyleItalic">major</span> nos doentes com SCA com o uso do acesso radial &#40;1&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;7&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">35</span></a>&#46; No entanto&#44; relativamente &#224; mortalidade os resultados n&#227;o foram consistentes&#44; tendo&#8208;se verificado redu&#231;&#227;o dela nos doentes com EAM com eleva&#231;&#227;o de ST&#44; mas n&#227;o nos doentes com SCA sem eleva&#231;&#227;o de ST<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">35</span></a>&#46; Mais recentemente&#44; o estudo MATRIX mostrou que o uso do acesso radial reduziu a taxa de complica&#231;&#245;es hemorr&#225;gicas e a mortalidade global dos doentes com SCA &#40;EAM com eleva&#231;&#227;o de ST e no EAM sem eleva&#231;&#227;o de ST&#41; comparativamente ao acesso femoral<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">27</span></a>&#46; Nesse contexto&#44; as <span class="elsevierStyleItalic">guidelines</span> europeias recomendam o uso do acesso vascular radial com classe de recomenda&#231;&#227;o I&#44; n&#237;vel de evid&#234;ncia A<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a elevada taxa de uso de acesso vascular radial poder&#225; ter contribu&#237;do para uma menor taxa de HMIH observada na nossa popula&#231;&#227;o&#46; A n&#227;o inclus&#227;o do tipo de acesso vascular &#233; uma limita&#231;&#227;o do <span class="elsevierStyleItalic">score</span> CRUSADE&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Fondaparinux</span><p id="par0170" class="elsevierStylePara elsevierViewall">Relativamente &#224; anticoagula&#231;&#227;o&#44; em 47&#44;9&#37; dos doentes foi usado fondaparinux&#44; valor bastante superior ao uso de enoxaparina &#40;16&#44;6&#37;&#41;&#46; No estudo OASIS&#8208;5&#44; nos doentes com SCA sem eleva&#231;&#227;o de ST&#44; o fondaparinux demonstrou reduzir significativamente os eventos hemorr&#225;gicos <span class="elsevierStyleItalic">major</span> comparativamente &#224; enoxaparina &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">36</span></a>&#46; Nesse contexto&#44; o fondaparinux &#233; o anticoagulante parent&#233;rico recomendado nos doentes com SCA sem eleva&#231;&#227;o de ST por apresentar o melhor perfil seguran&#231;a&#47;efic&#225;cia<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a>&#46; Apesar de as recomenda&#231;&#245;es atuais&#44; outras s&#233;ries reportam taxas mais baixas de uso do fondaparinux &#40;1&#44;6&#8208;14&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">1&#44;9&#44;37</span></a>&#46; Consideramos que o uso desse anticoagulante parent&#233;rico nos nossos doentes tamb&#233;m pode ter contribu&#237;do para uma menor taxa de hemorragia <span class="elsevierStyleItalic">major</span>&#46;</p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Inibidores de glicoprote&#237;nas IIb&#47;IIIa e inibidores dos recetores P2Y12</span><p id="par0175" class="elsevierStylePara elsevierViewall">Quanto ao uso de inibidores de IGP IIb&#47;IIIa&#44; em 49&#37; dos nossos doentes foi administrado esse f&#225;rmaco&#44; valor comparativamente superior a outras s&#233;ries publicadas &#40;5&#44;7&#8208;40&#44;2&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">1&#44;9&#44;18&#44;19&#44;37</span></a>&#46; Salienta&#8208;se que na maioria dos nossos doentes apenas foi administrado b&#243;lus de eptifibatide durante a coronariografia&#44; sem a perfus&#227;o do f&#225;rmaco ap&#243;s angioplastia&#44; facto que poder&#225; ter contribu&#237;do para a reduzida taxa de complica&#231;&#245;es hemorr&#225;gicas periprocedimento&#46; A evid&#234;ncia cient&#237;fica demonstrou que nos doentes com SCA sem eleva&#231;&#227;o de ST submetidos a ICP o uso de IGP conduziu &#224; redu&#231;&#227;o de eventos isqu&#233;micos&#44; principalmente atrav&#233;s da redu&#231;&#227;o reenfarte&#44; embora com aumento da taxa de hemorragia<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">6&#44;38</span></a>&#46; O estudo HORIZONS&#8208;AMI&#44; ao demonstrar superioridade da bivalirudina sobre a heparina combinada com IGP IIb&#47;IIIa nos doentes submetidos a ICP prim&#225;ria&#44; com a redu&#231;&#227;o significativa da taxa de hemorragia e redu&#231;&#227;o da mortalidade a 30 dias&#44; conduziu &#224; diminui&#231;&#227;o do uso dos IGP IIb&#47;IIIa<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">39</span></a>&#46; Atualmente&#44; as <span class="elsevierStyleItalic">guidelines</span> europeias apenas contemplam o uso dos IGP IIb&#47;IIIa na SCA para situa&#231;&#245;es de <span class="elsevierStyleItalic">bailout</span> ou na presen&#231;a de complica&#231;&#245;es tromb&#243;ticas &#40;IIa&#44;C&#41;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">10&#44;40</span></a>&#46; Contrariamente&#44; as <span class="elsevierStyleItalic">guidelines</span> americanas defendem que em doentes com SCA sem eleva&#231;&#227;o de ST de elevado risco e n&#227;o adequadamente pr&#233;&#8208;tratados com ticagrelor ou clopidogrel a administra&#231;&#227;o de um IGP IIb&#47;IIIa no momento da ICP &#233; &#250;til &#40;I&#44;A&#41;&#46; Ainda no grupo de doentes com SCA sem eleva&#231;&#227;o de ST de elevado risco&#44; naqueles que foram tratados com heparina n&#227;o fracionada e pr&#233;&#8208;tratados adequadamente com clopidogrel ou ticagrelor&#44; &#233; razo&#225;vel administrar IGP &#40;IIa&#44;B&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a>&#46; Real&#231;a&#8208;se que os nossos doentes fizeram preferencialmente um inibidor do recetor P2Y12 durante ou ap&#243;s a angioplastia&#44; dado que tamb&#233;m poder&#225; ter contribu&#237;do para uma menor taxa de hemorragia <span class="elsevierStyleItalic">major</span>&#46; Segundo as <span class="elsevierStyleItalic">guidelines</span> atuais&#44; os doentes com SCA devem receber pr&#233;&#8208;tratamento com um inibidor P2Y12<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">6&#44;10&#44;40</span></a>&#46; Contudo&#44; no caso do SCA sem eleva&#231;&#227;o de ST&#44; a evid&#234;ncia cient&#237;fica recente tem questionado o pr&#233;&#8208;tratamento<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">41&#44;42</span></a>&#44; como &#233; exemplo o estudo ACCOAST<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">42</span></a>&#44; que demonstrou que o pr&#233;&#8208;tratamento com prasugrel n&#227;o reduziu a taxa de eventos isqu&#233;micos e conduziu ao aumento da taxa de complica&#231;&#245;es hemorr&#225;gicas&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Implica&#231;&#245;es cl&#237;nicas</span><p id="par0180" class="elsevierStylePara elsevierViewall">&#201; reconhecido que a terap&#234;utica antitromb&#243;tica&#44; pe&#231;a fundamental no tratamento anti&#8208;isqu&#233;mico da SCA&#44; condiciona um maior risco hemorr&#225;gico&#46; Os doentes com SCA constituem uma popula&#231;&#227;o muito heterog&#233;nea e consequentemente&#44; para uma prescri&#231;&#227;o judiciosa&#44; &#233; necess&#225;rio estratificar o seu risco isqu&#233;mico e hemorr&#225;gico de modo a obter a mesma efic&#225;cia com redu&#231;&#227;o dos efeitos indesejados<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">31</span></a>&#46; No entanto&#44; na &#250;ltima d&#233;cada&#44; verificaram&#8208;se modifica&#231;&#245;es importantes na abordagem e na estrat&#233;gia terap&#234;utica dos doentes com SCA&#46; Essas altera&#231;&#245;es podem ter modificado o valor preditivo dos <span class="elsevierStyleItalic">scores</span> de risco<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a>&#46; Desse modo&#44; torna&#8208;se premente desenvolver ferramentas para estratificar o risco hemorr&#225;gico com o objetivo de privilegiar estrat&#233;gias que reduzam a taxa de hemorragia e consequentemente melhorem o progn&#243;stico desses doentes<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Limita&#231;&#245;es</span><p id="par0190" class="elsevierStylePara elsevierViewall">Trata&#8208;se de um estudo retrospetivo&#44; observacional&#44; unic&#234;ntrico e por esses motivos est&#225; sujeito a vi&#233;s inerente&#46; A baixa taxa de eventos hemorr&#225;gicos pode influenciar os resultados e&#44; nesse contexto&#44; devem ser validados numa maior coorte de doentes&#46; O uso de diferentes classifica&#231;&#245;es de hemorragia <span class="elsevierStyleItalic">major</span> &#233; outra limita&#231;&#227;o do nosso estudo&#46; No estudo CRUSADE&#44; a hemorragia <span class="elsevierStyleItalic">major</span> foi definida por hemorragia intracraniana&#44; retroperitoneal&#44; descida de hemat&#243;crito &#8805; 12&#37; relativamente ao valor basal&#44; transfus&#227;o de concentrado eritrocit&#225;rio quando o hemat&#243;crito basal era &#8805; 28&#37; ou transfus&#227;o de concentrado eritrocit&#225;rio quando o hemat&#243;crito basal era &#60;<span class="elsevierStyleHsp" style=""></span>28&#37; com hemorragia presenciada&#46; No nosso trabalho foi usada a classifica&#231;&#227;o de GUSTO&#44; que define hemorragia <span class="elsevierStyleItalic">major</span> como a ocorr&#234;ncia de hemorragia intracraniana ou hemorragia com compromisso hemodin&#226;mico que requer interven&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conclus&#227;o</span><p id="par0200" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a taxa de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar foi de 1&#44;8&#37;&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE&#44; apesar de apresentar algum poder discriminat&#243;rio&#44; sobrestimou de forma significativa a taxa de ocorr&#234;ncia de hemorragia&#44; principalmente no grupo de doentes com <span class="elsevierStyleItalic">score</span> mais elevado&#46; Os resultados deste estudo questionam se o <span class="elsevierStyleItalic">score</span> CRUSADE dever&#225; continuar a ser considerado na estratifica&#231;&#227;o do risco hemorr&#225;gico na SCA e consequentemente serem implantadas medidas espec&#237;ficas de acordo com o seu resultado&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conflitos de interesse</span><p id="par0195" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "titulo" => "Resumo"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A hemorragia <span class="elsevierStyleItalic">major</span> &#40;HM&#41; &#233; uma complica&#231;&#227;o grave da s&#237;ndrome coron&#225;ria aguda &#40;SCA&#41; e est&#225; associada a pior progn&#243;stico&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE permite estratificar o risco de HM na SCA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE numa popula&#231;&#227;o contempor&#226;nea de SCA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo unic&#234;ntrico e retrospetivo com 2818 doentes admitidos por SCA&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE foi calculado para cada doente&#44; a sua discrimina&#231;&#227;o e calibra&#231;&#227;o foram avaliadas pela &#225;rea abaixo da curva &#40;AUC&#41; <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> e pelo teste Hosmer&#8208;Lemeshow&#44; respetivamente&#46; Foram determinados os preditores de HM intra&#8208;hospitalar &#40;HMIH&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A taxa de HMIH foi de 1&#44;8&#37;&#44; valor significativamente inferior ao estimado pelo <span class="elsevierStyleItalic">score</span> CRUSADE &#40;7&#44;1&#37;&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A incid&#234;ncia de HMIH nas diferentes categorias foi de 0&#44;5&#37; na de muito baixo risco &#40;taxa estimada pelo <span class="elsevierStyleItalic">score</span> de 3&#44;1&#37;&#41;&#59; 1&#44;5&#37; na de baixo &#40;estimada de 5&#44;5&#37;&#41;&#59; 1&#44;6&#37; na de moderado &#40;estimada de 8&#44;6&#37;&#41;&#59; 5&#44;5&#37; na de elevado &#40;estimada de 11&#44;9&#37;&#41; e 4&#44;4&#37; na de muito elevado &#40;estimada de 19&#44;5&#37;&#41;&#46; A capacidade preditora do <span class="elsevierStyleItalic">score</span> CRUSADE para HMIH foi apenas moderada &#40;AUC 0&#44;73&#41;&#46; A taxa de mortalidade intra&#8208;hospitalar foi de 4&#44;0&#37;&#46; A idade mais avan&#231;ada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; o acesso vascular femoral &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; a frequ&#234;ncia card&#237;aca mais elevada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; e o ticagrelor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; foram preditores independentes de HMIH&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> CRUSADE&#44; apesar de apresentar algum poder discriminat&#243;rio&#44; sobrestimou de forma significativa a taxa de HMIH&#44; principalmente nos doentes de maior risco&#46; Esses resultados questionam se o <span class="elsevierStyleItalic">score</span> CRUSADE dever&#225; continuar a ser usado na estratifica&#231;&#227;o da SCA&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Major bleeding is a serious complication of acute coronary syndrome &#40;ACS&#41; and is associated with a worse prognosis&#46; The CRUSADE bleeding score is used to stratify the risk of major bleeding in ACS&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">To assess the predictive ability of the CRUSADE score in a contemporary ACS population&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">In a single&#8208;center retrospective study of 2818 patients admitted with ACS&#44; the CRUSADE score was calculated for each patient and its discrimination and goodness of fit were assessed by the area under the receiver operating characteristic curve &#40;AUC&#41; and by the Hosmer&#8208;Lemeshow test&#44; respectively&#46; Predictors of in&#8208;hospital major bleeding &#40;IHMB&#41; were determined&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">The IHMB rate was 1&#46;8&#37;&#44; significantly lower than predicted by the CRUSADE score &#40;7&#46;1&#37;&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The incidence of IHMB was 0&#46;5&#37; in the very low risk category &#40;rate predicted by the score 3&#46;1&#37;&#41;&#44; 1&#46;5&#37; in the low risk category &#40;5&#46;5&#37;&#41;&#44; 1&#46;6&#37; in the moderate risk category &#40;8&#46;6&#37;&#41;&#44; 5&#46;5&#37; in the high risk category &#40;11&#46;9&#37;&#41;&#44; and 4&#46;4&#37; in the very high risk category &#40;19&#46;5&#37;&#41;&#46; The predictive ability of the CRUSADE score for IHMB was only moderate &#40;AUC 0&#46;73&#41;&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">The in&#8208;hospital mortality rate was 4&#46;0&#37;&#46; Advanced age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#44; femoral vascular access &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#44; higher heart rate &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#41; and ticagrelor use &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41; were independent predictors of IHMB&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">The CRUSADE score&#44; although presenting some discriminatory power&#44; significantly overestimated the IHMB rate&#44; especially in patients at higher risk&#46; These results question whether the CRUSADE score should continue to be used in the stratification of ACS&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tabagismo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">28&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angioplastia coron&#225;ria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CABG<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfarte do mioc&#225;rdio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a vascular<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemorragia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Frequ&#234;ncia card&#237;aca &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Press&#227;o arterial sist&#243;lica &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">139<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acesso vascular femoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ICP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Terap&#234;utica antitromb&#243;tica &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clopidogrel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ticagrelor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inibidores GP IIb&#47;IIIa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fondaparinux&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enoxaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Observadan &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Esperada pelo <span class="elsevierStyleItalic">score</span> CRUSADE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Risco de hemorragia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n2615&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hemorragia observadan &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muito baixo &#91;1&#8208;20&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">931&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baixo &#91;21&#8208;30&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">681&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderado &#91;31&#8208;40&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">509&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevado &#91;41&#8208;50&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muito elevado &#91;&#62; 50&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2171098.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Hemorragia observada na nossa coorte <span class="elsevierStyleItalic">versu</span>s hemorragia estimada pelo <span class="elsevierStyleItalic">score</span> CRUSADE</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">DPOC&#58; Doen&#231;a pulmonar obstrutiva cr&#243;nica&#59; FEVE&#58; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda&#59; HMIH&#58; hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar&#59; HTA&#58; hipertens&#227;o arterial&#59; IC&#58; intervalo de confian&#231;a&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#46;</span></p>"
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            0 => array:2 [
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                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem HMIH<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;766&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Com HMIH<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR n&#227;o ajustado &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;65 &#40;2&#44;05&#8211;6&#44;92&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;31 &#40;1&#44;12&#8211;4&#44;76&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angina de peito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;13 &#40;1&#44;22&#8211;3&#44;72&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemorragia pr&#233;via&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;99 &#40;3&#44;87&#8211;16&#44;50&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;58 &#40;1&#44;08&#8211;6&#44;15&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neoplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;15 &#40;1&#44;91&#8211;9&#44;02&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;01 &#40;3&#44;15&#8211;8&#44;03&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobina &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;90 &#40;1&#44;06&#8211;5&#44;85&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acesso femoral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;10 &#40;3&#44;39&#8211;10&#44;97&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEVE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;15 &#40;3&#44;01&#8211;8&#44;57&#41;<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enoxaparina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;49 &#40;1&#44;38&#8211;4&#44;49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Varfarina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;48 &#40;1&#44;04&#8211;5&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ticagrelor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mortalidade&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Frequ&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;29 &#40;5&#44;01&#8211;10&#44;18&#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="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;92 &#40;1&#44;89&#8211;8&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "Bibliografia"
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        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0215"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Comparison of the Global Registry of Acute Coronary Events Risk Score Versus the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse outcomes With Early Implementation of the ACC&#47;AHA Guidelines Risk Score to Predict In&#8208;Hospital Mortality and Major Bleeding in Acute Coronary Syndromes"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Manzano-Fern&#225;ndez"
                            1 => "M&#46; S&#225;nchez-Mart&#237;nez"
                            2 => "P&#46;J&#46; Flores-Blanco"
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                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2015.12.048"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol&#46;"
                        "fecha" => "2016"
                        "volumen" => "117"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1054"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26857164"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0220"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Bleeding in acute coronary syndromes and percutaneous coronary interventions&#58; position paper by the Working Group on Thrombosis of the European Society of Cardiology"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;G&#46; Steg"
                            1 => "K&#46; Huber"
                            2 => "F&#46; Andreotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehr204"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "1854"
                        "paginaFinal" => "1864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21715717"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Standardized bleeding definitions for cardiovascular clinical trials&#58; a consensus report from the Bleeding Academic Research Consortium"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Mehran"
                            1 => "S&#46;V&#46; Rao"
                            2 => "D&#46;L&#46; Bhatt"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.009449"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2011"
                        "volumen" => "123"
                        "paginaInicial" => "2736"
                        "paginaFinal" => "2747"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21670242"
                            "web" => "Medline"
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              "identificador" => "bib0230"
              "etiqueta" => "4"
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                0 => array:2 [
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                      "titulo" => "Adverse impact of bleeding on prognosis in patients with acute coronary syndromes"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Eikelboom"
                            1 => "S&#46;R&#46; Mehta"
                            2 => "S&#46;S&#46; Anand"
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                      "doi" => "10.1161/CIRCULATIONAHA.106.612812"
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                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2006"
                        "volumen" => "114"
                        "paginaInicial" => "774"
                        "paginaFinal" => "782"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16908769"
                            "web" => "Medline"
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                      "titulo" => "Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;V&#46; Rao"
                            1 => "K&#46; O&#8217;Grady"
                            2 => "K&#46;S&#46; Pieper"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2005.06.056"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol&#46;"
                        "fecha" => "2005"
                        "volumen" => "96"
                        "paginaInicial" => "1200"
                        "paginaFinal" => "1206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16253582"
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                          "colaboracion" => "2014 AHA&#47;ACC Guideline for the management of patients with non&#8208;ST&#8208;elevation acute coronary syndromes&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force on Practice Guidelines"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;A&#46; Amsterdam"
                            1 => "N&#46;K&#46; Wenger"
                            2 => "R&#46;G&#46; Brindis"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2014.09.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2014"
                        "volumen" => "64"
                        "paginaInicial" => "e139"
                        "paginaFinal" => "e228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25260718"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                        0 => array:3 [
                          "colaboracion" => "Baseline risk of major bleeding in non&#8208;ST&#8208;segment&#8208;elevation myocardial infarction&#58; the CRUSADE &#40;Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC&#47;AHA Guidelines&#41; Bleeding Score"
                          "etal" => true
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                            0 => "S&#46; Subherwal"
                            1 => "R&#46;G&#46; Bach"
                            2 => "A&#46;Y&#46; Chen"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.108.828541"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2009"
                        "volumen" => "119"
                        "paginaInicial" => "1873"
                        "paginaFinal" => "1882"
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Artigo Original
Score CRUSADE – Será ainda um bom score para prever a hemorragia na síndrome coronária aguda?
CRUSADE: Is it still a good score to predict bleeding in acute coronary syndrome?
Dina Bentoa,
Autor para correspondência
dinabento@gmail.com

Autor para correspondência.
, Nuno Marquesa,b, Pedro Azevedoa, João Guedesa, João Bispoa, Daniela Silvaa, José Amadoa, Walter Santosa, Jorge Mimosoa, Ilídio de Jesusa
a Serviço de Cardiologia, Centro Hospitalar Universitário do Algarve, Faro, Portugal
b Algarve Biomedical Center, Faro, Portugal
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comorbilidades predisponentes&#44; avalia&#231;&#227;o de dados anal&#237;ticos e o uso de um <span class="elsevierStyleItalic">score</span> de risco hemorr&#225;gico<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> CRUSADE<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a> foi desenvolvido numa popula&#231;&#227;o abrangente de doentes com SCA sem eleva&#231;&#227;o de ST para avaliar o risco hemorr&#225;gico e&#44; mais recentemente&#44; foi tamb&#233;m validado no EAM com eleva&#231;&#227;o de ST<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">8</span></a>&#46; Esse <span class="elsevierStyleItalic">score</span> contempla oito vari&#225;veis que incluem caracter&#237;sticas basais&#44; vari&#225;veis cl&#237;nicas e valores laboratoriais na admiss&#227;o<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#46; Atualmente&#44; &#233; o m&#233;todo mais usado para determinar o risco hemorr&#225;gico por ter demonstrado melhor poder discriminat&#243;rio<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">6&#44;9&#44;10</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O uso do <span class="elsevierStyleItalic">score</span> CRUSADE tem como objetivo estratificar os doentes com SCA&#44; permite escolher estrat&#233;gias terap&#234;uticas mais adequadas de modo a reduzir o risco de hemorragia e consequentemente melhorar o progn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Com este estudo&#44; os autores pretendem analisar a aplicabilidade do <span class="elsevierStyleItalic">score</span> CRUSADE nos doentes com SCA&#44; considerando que nos &#250;ltimos 10 anos se verificaram modifica&#231;&#245;es importantes na abordagem e no tratamento desses doentes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Desenho do estudo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudo retrospetivo&#44; descritivo e correlacional do Centro Hospitalar Universit&#225;rio do Algarve com doentes admitidos com o diagn&#243;stico de SCA no servi&#231;o de Cardiologia de 1 de outubro de 2010 a 31 de agosto de 2014&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE foi calculado para cada doente e foi avaliada a capacidade de predi&#231;&#227;o de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar &#40;HMIH&#41;&#46; Foram avaliados os preditores de HMIH&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sele&#231;&#227;o de doentes</span><p id="par0035" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 2818 doentes com o diagn&#243;stico de s&#237;ndrome coron&#225;ria aguda com evolu&#231;&#227;o inferior a 48<span class="elsevierStyleHsp" style=""></span>h&#46; O diagn&#243;stico de EAM foi definido como a presen&#231;a de dor tor&#225;cica ou equivalente anginoso nas &#250;ltimas 48<span class="elsevierStyleHsp" style=""></span>h associada a altera&#231;&#245;es eletrocardiogr&#225;ficas isqu&#233;micas &#40;desvios do segmento ST ou ondas T negativas&#41; e eleva&#231;&#227;o de troponina acima do valor de refer&#234;ncia&#46; O diagn&#243;stico de angina inst&#225;vel foi definido pela presen&#231;a de dor tor&#225;cica ou equivalente anginoso associada ou n&#227;o a altera&#231;&#245;es eletrocardiogr&#225;ficas isqu&#233;micas na aus&#234;ncia de eleva&#231;&#227;o de troponina acima do valor de refer&#234;ncia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Foram exclu&#237;dos os doentes com EAM ap&#243;s procedimentos de revasculariza&#231;&#227;o &#40;EAM tipo 4 e 5&#41; e com EAM tipo 2 &#40;classifica&#231;&#227;o de acordo com a redefini&#231;&#227;o de Enfarte do Mioc&#225;rdio de 2007<span class="elsevierStyleHsp" style=""></span>da Joint ESC&#47;ACCF&#47;AHA&#47;WHF Task Force&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Na an&#225;lise da capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE&#44; dos 2818 doentes foram exclu&#237;dos 203 &#40;7&#44;2&#37;&#41; devido &#224; impossibilidade de calcular o respetivo <span class="elsevierStyleItalic">score&#46;</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Colheita de dados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram colhidos dados demogr&#225;ficos &#40;idade e g&#233;nero&#41;&#44; antecedentes pessoais relevantes &#40;antecedentes de EAM&#44; insufici&#234;ncia card&#237;aca&#44; interven&#231;&#227;o coron&#225;ria percut&#226;nea &#91;ICP&#93;&#44; cirurgia de revasculariza&#231;&#227;o mioc&#225;rdica&#44; hemorragia&#44; angina de peito&#44; doen&#231;a pulmonar obstrutiva cr&#243;nica &#91;DPOC&#93; e neoplasia&#41;&#44; fatores de risco cardiovascular &#40;hipertens&#227;o arterial &#91;HTA&#93;&#44; diabetes&#44; dislipidemia e tabagismo atual&#41;&#46; Foram avaliados dados relacionados com o internamento&#44; nomeadamente dados cl&#237;nicos na admiss&#227;o &#40;press&#227;o arterial sist&#243;lica&#44; frequ&#234;ncia card&#237;aca e hemat&#243;crito&#41;&#44; dados da coronariografia &#40;acesso vascular e feitura de angioplastia&#41;&#44; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda&#44; tipo de SCA &#40;EAM com eleva&#231;&#227;o do segmento ST&#44; EAM sem eleva&#231;&#227;o do segmento ST&#44; EAM de localiza&#231;&#227;o indeterminada e angina inst&#225;vel&#41;&#44; medica&#231;&#227;o administrada &#40;&#225;cido acetilsalic&#237;lico &#91;AAS&#93;&#44; clopidogrel&#44; ticagrelor&#44; enoxaparina&#44; heparina n&#227;o fracionada&#44; fondaparinux&#44; varfarina&#44; inibidor das glicoprote&#237;nas IIb&#47;IIIa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A clearance de creatinina foi estimada com a f&#243;rmula de Cockcroft&#8208;Gault&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A doen&#231;a vascular foi definida por antecedentes de doen&#231;a arterial perif&#233;rica e&#47;ou acidente vascular cerebral&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Mortalidade intra&#8208;hospitalar &#40;MIH&#41; foi definida como morte de qualquer causa ocorrida durante o internamento por SCA&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105"><span class="elsevierStyleItalic">Endpoint</span> do estudo</span><p id="par0070" class="elsevierStylePara elsevierViewall">Os <span class="elsevierStyleItalic">endpoints</span> deste estudo correspondem &#224; avalia&#231;&#227;o da capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE de HMIH e &#224; determina&#231;&#227;o dos preditores independentes de HMIH&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar &#40;HMIH&#41; foi definida segundo a classifica&#231;&#227;o de GUSTO como a ocorr&#234;ncia de hemorragia intracraniana ou hemorragia com compromisso hemodin&#226;mico requerendo interven&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">13</span></a>&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE foi calculado para cada doente atrav&#233;s das oito vari&#225;veis &#40;hemat&#243;crito basal&#44; taxa de filtra&#231;&#227;o glomerular&#44; frequ&#234;ncia card&#237;aca na admiss&#227;o&#44; press&#227;o arterial sist&#243;lica na admiss&#227;o&#44; sinais de insufici&#234;ncia card&#237;aca na admiss&#227;o&#44; g&#233;nero&#44; hist&#243;ria de doen&#231;a vascular e diabetes <span class="elsevierStyleItalic">mellitus</span>&#41;&#46; Foram estabelecidas cinco categorias de risco de hemorragia grave durante o internamento segundo os pontos de corte e intervalos definidos pelos investigadores do CRUSADE<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#44; designadamente muito baixo risco &#40;pontua&#231;&#227;o inferior a 20&#41;&#44; baixo &#40;21 a 30 pontos&#41;&#44; moderado &#40;31 a 40 pontos&#41;&#44; elevado &#40;41 a 50 pontos&#41; e muito elevado &#40;superior a 50&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">An&#225;lise estat&#237;stica</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foi efetuada an&#225;lise descritiva para a caracteriza&#231;&#227;o do perfil amostral&#46; As vari&#225;veis cont&#237;nuas s&#227;o apresentadas como m&#233;dia e desvio padr&#227;o&#46; As vari&#225;veis categ&#243;ricas s&#227;o apresentadas em n&#250;mero &#40;percentagem&#41;&#46; Para cada doente foi calculado o <span class="elsevierStyleItalic">score</span> CRUSADE&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE na nossa popula&#231;&#227;o foi testada por an&#225;lise da &#225;rea abaixo da curva &#40;AUC&#41; <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> &#40;ROC&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">14</span></a> e a calibra&#231;&#227;o do modelo pelo teste de Hosmer&#8208;Lemeshow &#40;H&#8208;L&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">15</span></a>&#46; Com o teste H&#8208;L&#44; um modelo ter&#225; uma calibra&#231;&#227;o adequada se o valor de p n&#227;o for significativo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Para averigua&#231;&#227;o da exist&#234;ncia de associa&#231;&#227;o entre vari&#225;veis de natureza categ&#243;rica aplicou&#8208;se o teste de qui&#8208;quadrado&#44; na presen&#231;a de uma vari&#225;vel cont&#237;nua aplicou&#8208;se o teste <span class="elsevierStyleItalic">t</span> de Student<span class="elsevierStyleItalic">&#46;</span></p><p id="par0095" class="elsevierStylePara elsevierViewall">Para aferi&#231;&#227;o de preditores de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar aplicou&#8208;se uma regress&#227;o log&#237;stica bin&#225;ria&#46; Considerou&#8208;se como n&#237;vel de signific&#226;ncia de 95&#37; com um valor p inferior a 0&#44;05&#46; A an&#225;lise estat&#237;stica foi feita com o <span class="elsevierStyleItalic">software</span> IBM SPSS <span class="elsevierStyleItalic">Statistics</span> &#40;<span class="elsevierStyleItalic">version 20&#46;</span>0&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Caracter&#237;sticas da popula&#231;&#227;o</span><p id="par0100" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas basais da popula&#231;&#227;o do estudo est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 2818 doentes com SCA&#44; 73&#44;9&#37; do g&#233;nero masculino&#44; com idade m&#233;dia de 66 &#177; 13 anos&#46; Na admiss&#227;o hospitalar&#44; os doentes tinham um hemat&#243;crito m&#233;dio de 41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#37;&#44; frequ&#234;ncia card&#237;aca m&#233;dia de 77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 bpm&#44; press&#227;o arterial sist&#243;lica m&#233;dia de 139<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mmHg&#44; taxa de filtra&#231;&#227;o glomerular m&#233;dia de 81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37<span class="elsevierStyleHsp" style=""></span>ml&#47;min e 10&#44;9&#37; apresentavam sinais de insufici&#234;ncia card&#237;aca&#46; O diagn&#243;stico de admiss&#227;o mais frequente foi o EAM sem eleva&#231;&#227;o de ST &#40;48&#44;4&#37;&#41;&#44; seguido do EAM com eleva&#231;&#227;o de ST &#40;44&#44;4&#37;&#41;&#46; Foi feita coronariografia em 75&#44;3&#37; dos doentes&#44; 91&#44;5&#37; atrav&#233;s de acesso vascular radial e 58&#44;3&#37; foram submetidos a angioplastia coron&#225;ria&#46; Relativamente &#224; terap&#234;utica antitromb&#243;tica no internamento&#44; 96&#44;8&#37; dos doentes receberam aspirina&#44; 73&#37; clopidogrel&#44; 2&#44;8&#37; ticagrelor e 47&#44;9&#37; fondaparinux&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Durante o internamento&#44; 113 &#40;4&#44;0&#37;&#41; doentes faleceram e 52 &#40;1&#44;8&#37;&#41; apresentaram HMIH&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Poder discriminat&#243;rio do <span class="elsevierStyleItalic">score</span> CRUSADE</span><p id="par0115" class="elsevierStylePara elsevierViewall">A hemorragia estimada pelo <span class="elsevierStyleItalic">score</span> CRUSADE para a nossa popula&#231;&#227;o foi de 7&#44;1&#37;&#44; valor estatisticamente diferente do que obtivemos &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46; A incid&#234;ncia de HMIH nas diferentes categorias do <span class="elsevierStyleItalic">score</span> CRUSADE foi de 0&#44;5&#37; na de muito baixo risco &#40;taxa estimada pelo <span class="elsevierStyleItalic">score</span> de 3&#44;1&#37;&#41;&#59; 1&#44;5&#37; na de baixo &#40;estimada de 5&#44;5&#37;&#41;&#59; 1&#44;6&#37; na de moderado &#40;estimada de 8&#44;6&#37;&#41;&#59; 5&#44;5&#37; na de elevado &#40;estimada de 11&#44;9&#37;&#41; e 4&#44;4&#37; na de muito elevado &#40;estimada de 19&#44;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46; A capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE na nossa popula&#231;&#227;o foi moderada&#44; com uma &#225;rea abaixo da curva ROC de 0&#44;73 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Preditores de hemorragia <span class="elsevierStyleItalic">major</span> durante o internamento</span><p id="par0120" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">endpoint</span> HMIH associou&#8208;se &#224;s seguintes vari&#225;veis&#58; idade mais avan&#231;ada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; HTA &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#44; angina de peito &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; hemorragia pr&#233;via &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; DPOC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#44; neoplasia &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; frequ&#234;ncia card&#237;aca mais elevada na admiss&#227;o &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; menor valor de hemoglobina &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; acesso vascular femoral &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e menor fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda &#40;FEVE&#41; na alta hospitalar &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A HMIH associou&#8208;se a maior mortalidade intra&#8208;hospitalar &#40;15&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;8&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Quando inclu&#237;das em an&#225;lise multivariada todas as associa&#231;&#245;es significativas previamente referidas&#44; a idade mais avan&#231;ada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; o acesso vascular femoral &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; a frequ&#234;ncia card&#237;aca mais elevada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; e a toma de ticagrelor durante o internamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; foram preditores de HMIH &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discuss&#227;o</span><p id="par0130" class="elsevierStylePara elsevierViewall">Na nossa popula&#231;&#227;o contempor&#226;nea de doentes com SCA&#44; o <span class="elsevierStyleItalic">score</span> CRUSADE sobrestimou o risco de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar&#46;</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar</span><p id="par0135" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a taxa de HMIH foi de 1&#44;8&#37;&#46; Na literatura&#44; a incid&#234;ncia de HMIH varia entre 1&#8208;10&#37;&#44; cuja variabilidade &#233; secund&#225;ria a v&#225;rios fatores&#44; como s&#227;o exemplo diferen&#231;as nas caracter&#237;sticas dos doentes&#44; terap&#234;uticas concomitantes e diferentes defini&#231;&#245;es de hemorragia usadas<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A taxa de HMIH obtida foi significativamente inferior &#224; esperado pelo <span class="elsevierStyleItalic">score</span> CRUSADE &#40;7&#44;1&#37;&#41; para a nossa popula&#231;&#227;o &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Quando comparadas as v&#225;rias categorias de risco&#44; verificou&#8208;se que o <span class="elsevierStyleItalic">score</span> CRUSADE sobrestimou a taxa de HMIH em todas as categorias&#46; Observaram&#8208;se maiores diferen&#231;as nas categorias de risco mais elevadas &#40;risco moderado&#44; elevado e muito elevado&#41;&#46; Esses resultados podem ser explicados pela evid&#234;ncia de que a taxa de HMIH nos doentes com SCA tem reduzido ao longo do tempo&#44; apesar do uso de terap&#234;uticas farmacol&#243;gicas e de interven&#231;&#227;o mais agressivas&#46; Fox et al<span class="elsevierStyleItalic">&#46;</span>&#44; entre 2000 e 2007&#44; reportaram uma redu&#231;&#227;o significativa nas taxas de hemorragia de 2&#44;6&#37; para 1&#44;8&#37; nos doentes com SCA &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">16</span></a>&#46; V&#225;rios fatores poder&#227;o ter contribu&#237;do para esses resultados&#44; como s&#227;o exemplo a melhoria da t&#233;cnica da cateteriza&#231;&#227;o card&#237;aca&#44; o uso de cateteres de menor calibre&#44; o uso do acesso vascular radial&#44; melhor sele&#231;&#227;o da terap&#234;utica antitromb&#243;tica ou altera&#231;&#227;o do limiar para transfus&#227;o de concentrado eritrocit&#225;rio<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">16</span></a>&#46; &#201; reconhecido que os doentes com HMIH apresentam pior progn&#243;stico&#44; com maior risco de mortalidade intra&#8208;hospitalar<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; No estudo de Spencer et al<span class="elsevierStyleItalic">&#46;</span>&#44; com 40 087 doentes com SCA&#44; a HMIH associou&#8208;se a maior mortalidade intra&#8208;hospitalar &#40;21&#37; <span class="elsevierStyleItalic">versus</span> 6&#37;&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">17</span></a>&#46; No nosso estudo&#44; a HMIH tamb&#233;m se associou a maior mortalidade &#40;15&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;8&#37;&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A HMIH tem um impacto negativo no progn&#243;stico dos doentes com SCA&#44; &#233; necess&#225;rio implantar estrat&#233;gias para a sua redu&#231;&#227;o&#46; N&#227;o obstante&#44; v&#225;rios preditores de hemorragia s&#227;o tamb&#233;m preditores de eventos isqu&#234;micos&#44; o que dificulta a obten&#231;&#227;o da m&#225;xima efic&#225;cia anti&#8208;isqu&#233;mica com m&#237;nimo risco hemorr&#225;gico<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">7&#44;10</span></a>&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Poder discriminat&#243;rio do <span class="elsevierStyleItalic">score</span> CRUSADE</span><p id="par0145" class="elsevierStylePara elsevierViewall">Na nossa popula&#231;&#227;o&#44; a capacidade preditora do <span class="elsevierStyleItalic">score</span> CRUSADE para HMIH foi aceit&#225;vel&#44; com uma &#225;rea abaixo da curva ROC de 0&#44;73&#46; No entanto&#44; esse resultado n&#227;o &#233; &#243;timo&#46; Abu&#8208;Assi et al<span class="elsevierStyleItalic">&#46;</span> avaliaram a performance do <span class="elsevierStyleItalic">score</span> CRUSADE numa coorte de 4500 doentes com SCA e objetivaram um poder discriminat&#243;rio de 0&#44;80 na predi&#231;&#227;o de hemorragia <span class="elsevierStyleItalic">major</span><a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#46; Similarmente&#44; Manzano&#8208;Fern&#225;ndez et al<span class="elsevierStyleItalic">&#46;</span> em 1587 doentes com SCA relataram um poder discriminat&#243;rio de 0&#44;79<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a>&#46; Contrariamente&#44; outras s&#233;ries reportaram um pior poder discriminat&#243;rio&#46; Ariza&#8208;Sol&#233; et al<span class="elsevierStyleItalic">&#46;</span>&#44; em 1976 doentes com SCA&#44; determinaram um poder discriminat&#243;rio de 0&#44;70<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">18</span></a>&#46; Amador et al<span class="elsevierStyleItalic">&#46;</span>&#44; em 516 doentes com SCA sem eleva&#231;&#227;o de ST&#44; objetivaram uma AUC de 0&#44;61<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">19</span></a>&#46; Em determinados subgrupos de popula&#231;&#245;es&#44; como s&#227;o exemplo os doentes com idade superior a 75 anos&#44; os que n&#227;o fizeram coronariografia e os anticoagulados previamente&#44; foi demonstrado que o <span class="elsevierStyleItalic">score</span> CRUSADE tem uma capacidade preditiva muito modesta com AUC inferiores a 0&#44;70<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">9&#44;20&#44;21</span></a>&#46; Na verdade&#44; relativamente aos doentes sob estrat&#233;gia conservadora&#44; o desempenho do CRUSADE foi modesto na popula&#231;&#227;o na qual foi desenvolvido o <span class="elsevierStyleItalic">score</span>&#44; com uma AUC de 0&#44;68<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a>&#46; Desse modo&#44; verifica&#8208;se uma importante heterogeneidade no poder discriminat&#243;rio do <span class="elsevierStyleItalic">score</span> CRUSADE nos doentes com SCA&#46; V&#225;rios fatores podem contribuir para essas diferen&#231;as e dificultar a avalia&#231;&#227;o do risco hemorr&#225;gico&#44; como s&#227;o exemplo a idade&#44; as comorbilidades&#44; a terap&#234;utica antitromb&#243;tica institu&#237;da&#44; a estrat&#233;gia escolhida &#40;invasiva ou conservadora&#41; ou o acesso vascular da coronariografia&#46; &#201; necess&#225;rio desenvolver um <span class="elsevierStyleItalic">score</span> adequado &#224; pr&#225;tica cl&#237;nica atual que permita a correta&#44; personalizada e acess&#237;vel estratifica&#231;&#227;o dos doentes com SCA&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Preditores de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar</span><p id="par0150" class="elsevierStylePara elsevierViewall">No nosso estudo determin&#225;mos como preditores independentes de HMIH a idade mais avan&#231;ada&#44; a frequ&#234;ncia card&#237;aca mais elevada na admiss&#227;o&#44; o acesso vascular via femoral e a toma de ticagrelor durante o internamento&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Como referido previamente&#44; os doentes com SCA s&#227;o heterog&#233;neos o que condiciona a determina&#231;&#227;o de diferentes preditores em diferentes popula&#231;&#245;es de doentes&#46; O estudo de Mehran et al<span class="elsevierStyleItalic">&#46;</span> com 17421 doentes com SCA determinou sete preditores de hemorragia&#44; nomeadamente g&#233;nero feminino&#44; idade avan&#231;ada&#44; creatinina s&#233;rica elevada&#44; contagem de leuc&#243;citos&#44; anemia e uso de heparina n&#227;o fracionada com inibidor GP IIb&#47;IIIa<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">22</span></a>&#46; Moscucci et al<span class="elsevierStyleItalic">&#46;</span>&#44; no registo GRACE com 24&#46;045 doentes com SCA&#44; identificaram como preditores g&#233;nero feminino&#44; idade avan&#231;ada&#44; insufici&#234;ncia renal e hist&#243;ria pr&#233;via de hemorragia<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">23</span></a>&#46; Nikolsky et al<span class="elsevierStyleItalic">&#46;</span>&#44; al&#233;m da idade&#44; do g&#233;nero feminino e da insufici&#234;ncia renal&#44; determinaram a anemia pr&#233;&#8208;existente&#44; administra&#231;&#227;o de heparina de baixo peso molecular nas 48<span class="elsevierStyleHsp" style=""></span>h antes da ICP e o uso de bal&#227;o intra&#8208;a&#243;rtico como preditores de hemorragia<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">24</span></a>&#46; Apesar de as diferen&#231;as na incid&#234;ncia e na defini&#231;&#227;o de hemorragia entre os estudos&#44; a idade&#44; o g&#233;nero feminino e a insufici&#234;ncia renal s&#227;o vari&#225;veis frequentemente identificadas<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">2&#44;22&#44;23</span></a>&#46; No nosso estudo&#44; o ticagrelor foi preditor de HMIH&#46; Esse resultado tem de ser interpretado no contexto de que apenas 2&#44;8&#37; dos doentes tomaram esse f&#225;rmaco&#46; No estudo PLATO<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">25</span></a>&#44; a toma de ticagrelor demonstrou reduzir a mortalidade cerebrovascular e cardiovascular&#44; o EAM e o AVC&#44; mas associou&#8208;se a maior taxa de hemorragia <span class="elsevierStyleItalic">major</span> n&#227;o relacionada com cirurgia de revasculariza&#231;&#227;o mioc&#225;rdica comparativamente ao clopidogrel &#40;4&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; <a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">25</span></a>&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Acesso vascular da coronariografia</span><p id="par0160" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; 91&#44;5&#37; dos doentes fizeram coronariografia por acesso vascular radial&#44; valor que &#233; superior a outras s&#233;ries publicadas que avaliaram a aplicabilidade do CRUSADE e que reportaram taxas entre 64&#8208;83&#44;1&#37;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">1&#44;9&#44;18&#44;26</span></a>&#46; Na an&#225;lise multivariada&#44; o acesso vascular femoral foi preditor independente de HMIH &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; resultado que est&#225; de acordo com a evid&#234;ncia cl&#237;nica mais recente<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; No entanto&#44; importa salientar que esse resultado tem de ser interpretado no contexto de que apenas 8&#44;5&#37; dos doentes fizeram coronariografia por acesso vascular femoral&#46; Nos doentes submetidos a ICP&#44; a hemorragia <span class="elsevierStyleItalic">major</span> periprocedimento &#233; uma complica&#231;&#227;o poss&#237;vel com incid&#234;ncia de 1&#44;7&#8208;3&#44;5&#37; nas s&#233;ries mais contempor&#226;neas<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">29&#8211;31</span></a>&#46; V&#225;rias s&#233;ries mostraram que o acesso vascular radial est&#225; associado a menor taxa de complica&#231;&#245;es hemorr&#225;gicas periprocedimento comparativamente ao acesso femoral<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">32&#8211;35</span></a>&#46; O estudo RIVAL reportou redu&#231;&#227;o das complica&#231;&#245;es vasculares <span class="elsevierStyleItalic">major</span> nos doentes com SCA com o uso do acesso radial &#40;1&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 3&#44;7&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">35</span></a>&#46; No entanto&#44; relativamente &#224; mortalidade os resultados n&#227;o foram consistentes&#44; tendo&#8208;se verificado redu&#231;&#227;o dela nos doentes com EAM com eleva&#231;&#227;o de ST&#44; mas n&#227;o nos doentes com SCA sem eleva&#231;&#227;o de ST<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">35</span></a>&#46; Mais recentemente&#44; o estudo MATRIX mostrou que o uso do acesso radial reduziu a taxa de complica&#231;&#245;es hemorr&#225;gicas e a mortalidade global dos doentes com SCA &#40;EAM com eleva&#231;&#227;o de ST e no EAM sem eleva&#231;&#227;o de ST&#41; comparativamente ao acesso femoral<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">27</span></a>&#46; Nesse contexto&#44; as <span class="elsevierStyleItalic">guidelines</span> europeias recomendam o uso do acesso vascular radial com classe de recomenda&#231;&#227;o I&#44; n&#237;vel de evid&#234;ncia A<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a elevada taxa de uso de acesso vascular radial poder&#225; ter contribu&#237;do para uma menor taxa de HMIH observada na nossa popula&#231;&#227;o&#46; A n&#227;o inclus&#227;o do tipo de acesso vascular &#233; uma limita&#231;&#227;o do <span class="elsevierStyleItalic">score</span> CRUSADE&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Fondaparinux</span><p id="par0170" class="elsevierStylePara elsevierViewall">Relativamente &#224; anticoagula&#231;&#227;o&#44; em 47&#44;9&#37; dos doentes foi usado fondaparinux&#44; valor bastante superior ao uso de enoxaparina &#40;16&#44;6&#37;&#41;&#46; No estudo OASIS&#8208;5&#44; nos doentes com SCA sem eleva&#231;&#227;o de ST&#44; o fondaparinux demonstrou reduzir significativamente os eventos hemorr&#225;gicos <span class="elsevierStyleItalic">major</span> comparativamente &#224; enoxaparina &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">36</span></a>&#46; Nesse contexto&#44; o fondaparinux &#233; o anticoagulante parent&#233;rico recomendado nos doentes com SCA sem eleva&#231;&#227;o de ST por apresentar o melhor perfil seguran&#231;a&#47;efic&#225;cia<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a>&#46; Apesar de as recomenda&#231;&#245;es atuais&#44; outras s&#233;ries reportam taxas mais baixas de uso do fondaparinux &#40;1&#44;6&#8208;14&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">1&#44;9&#44;37</span></a>&#46; Consideramos que o uso desse anticoagulante parent&#233;rico nos nossos doentes tamb&#233;m pode ter contribu&#237;do para uma menor taxa de hemorragia <span class="elsevierStyleItalic">major</span>&#46;</p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Inibidores de glicoprote&#237;nas IIb&#47;IIIa e inibidores dos recetores P2Y12</span><p id="par0175" class="elsevierStylePara elsevierViewall">Quanto ao uso de inibidores de IGP IIb&#47;IIIa&#44; em 49&#37; dos nossos doentes foi administrado esse f&#225;rmaco&#44; valor comparativamente superior a outras s&#233;ries publicadas &#40;5&#44;7&#8208;40&#44;2&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">1&#44;9&#44;18&#44;19&#44;37</span></a>&#46; Salienta&#8208;se que na maioria dos nossos doentes apenas foi administrado b&#243;lus de eptifibatide durante a coronariografia&#44; sem a perfus&#227;o do f&#225;rmaco ap&#243;s angioplastia&#44; facto que poder&#225; ter contribu&#237;do para a reduzida taxa de complica&#231;&#245;es hemorr&#225;gicas periprocedimento&#46; A evid&#234;ncia cient&#237;fica demonstrou que nos doentes com SCA sem eleva&#231;&#227;o de ST submetidos a ICP o uso de IGP conduziu &#224; redu&#231;&#227;o de eventos isqu&#233;micos&#44; principalmente atrav&#233;s da redu&#231;&#227;o reenfarte&#44; embora com aumento da taxa de hemorragia<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">6&#44;38</span></a>&#46; O estudo HORIZONS&#8208;AMI&#44; ao demonstrar superioridade da bivalirudina sobre a heparina combinada com IGP IIb&#47;IIIa nos doentes submetidos a ICP prim&#225;ria&#44; com a redu&#231;&#227;o significativa da taxa de hemorragia e redu&#231;&#227;o da mortalidade a 30 dias&#44; conduziu &#224; diminui&#231;&#227;o do uso dos IGP IIb&#47;IIIa<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">39</span></a>&#46; Atualmente&#44; as <span class="elsevierStyleItalic">guidelines</span> europeias apenas contemplam o uso dos IGP IIb&#47;IIIa na SCA para situa&#231;&#245;es de <span class="elsevierStyleItalic">bailout</span> ou na presen&#231;a de complica&#231;&#245;es tromb&#243;ticas &#40;IIa&#44;C&#41;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">10&#44;40</span></a>&#46; Contrariamente&#44; as <span class="elsevierStyleItalic">guidelines</span> americanas defendem que em doentes com SCA sem eleva&#231;&#227;o de ST de elevado risco e n&#227;o adequadamente pr&#233;&#8208;tratados com ticagrelor ou clopidogrel a administra&#231;&#227;o de um IGP IIb&#47;IIIa no momento da ICP &#233; &#250;til &#40;I&#44;A&#41;&#46; Ainda no grupo de doentes com SCA sem eleva&#231;&#227;o de ST de elevado risco&#44; naqueles que foram tratados com heparina n&#227;o fracionada e pr&#233;&#8208;tratados adequadamente com clopidogrel ou ticagrelor&#44; &#233; razo&#225;vel administrar IGP &#40;IIa&#44;B&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a>&#46; Real&#231;a&#8208;se que os nossos doentes fizeram preferencialmente um inibidor do recetor P2Y12 durante ou ap&#243;s a angioplastia&#44; dado que tamb&#233;m poder&#225; ter contribu&#237;do para uma menor taxa de hemorragia <span class="elsevierStyleItalic">major</span>&#46; Segundo as <span class="elsevierStyleItalic">guidelines</span> atuais&#44; os doentes com SCA devem receber pr&#233;&#8208;tratamento com um inibidor P2Y12<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">6&#44;10&#44;40</span></a>&#46; Contudo&#44; no caso do SCA sem eleva&#231;&#227;o de ST&#44; a evid&#234;ncia cient&#237;fica recente tem questionado o pr&#233;&#8208;tratamento<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">41&#44;42</span></a>&#44; como &#233; exemplo o estudo ACCOAST<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">42</span></a>&#44; que demonstrou que o pr&#233;&#8208;tratamento com prasugrel n&#227;o reduziu a taxa de eventos isqu&#233;micos e conduziu ao aumento da taxa de complica&#231;&#245;es hemorr&#225;gicas&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Implica&#231;&#245;es cl&#237;nicas</span><p id="par0180" class="elsevierStylePara elsevierViewall">&#201; reconhecido que a terap&#234;utica antitromb&#243;tica&#44; pe&#231;a fundamental no tratamento anti&#8208;isqu&#233;mico da SCA&#44; condiciona um maior risco hemorr&#225;gico&#46; Os doentes com SCA constituem uma popula&#231;&#227;o muito heterog&#233;nea e consequentemente&#44; para uma prescri&#231;&#227;o judiciosa&#44; &#233; necess&#225;rio estratificar o seu risco isqu&#233;mico e hemorr&#225;gico de modo a obter a mesma efic&#225;cia com redu&#231;&#227;o dos efeitos indesejados<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">31</span></a>&#46; No entanto&#44; na &#250;ltima d&#233;cada&#44; verificaram&#8208;se modifica&#231;&#245;es importantes na abordagem e na estrat&#233;gia terap&#234;utica dos doentes com SCA&#46; Essas altera&#231;&#245;es podem ter modificado o valor preditivo dos <span class="elsevierStyleItalic">scores</span> de risco<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a>&#46; Desse modo&#44; torna&#8208;se premente desenvolver ferramentas para estratificar o risco hemorr&#225;gico com o objetivo de privilegiar estrat&#233;gias que reduzam a taxa de hemorragia e consequentemente melhorem o progn&#243;stico desses doentes<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a>&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Limita&#231;&#245;es</span><p id="par0190" class="elsevierStylePara elsevierViewall">Trata&#8208;se de um estudo retrospetivo&#44; observacional&#44; unic&#234;ntrico e por esses motivos est&#225; sujeito a vi&#233;s inerente&#46; A baixa taxa de eventos hemorr&#225;gicos pode influenciar os resultados e&#44; nesse contexto&#44; devem ser validados numa maior coorte de doentes&#46; O uso de diferentes classifica&#231;&#245;es de hemorragia <span class="elsevierStyleItalic">major</span> &#233; outra limita&#231;&#227;o do nosso estudo&#46; No estudo CRUSADE&#44; a hemorragia <span class="elsevierStyleItalic">major</span> foi definida por hemorragia intracraniana&#44; retroperitoneal&#44; descida de hemat&#243;crito &#8805; 12&#37; relativamente ao valor basal&#44; transfus&#227;o de concentrado eritrocit&#225;rio quando o hemat&#243;crito basal era &#8805; 28&#37; ou transfus&#227;o de concentrado eritrocit&#225;rio quando o hemat&#243;crito basal era &#60;<span class="elsevierStyleHsp" style=""></span>28&#37; com hemorragia presenciada&#46; No nosso trabalho foi usada a classifica&#231;&#227;o de GUSTO&#44; que define hemorragia <span class="elsevierStyleItalic">major</span> como a ocorr&#234;ncia de hemorragia intracraniana ou hemorragia com compromisso hemodin&#226;mico que requer interven&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conclus&#227;o</span><p id="par0200" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a taxa de hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar foi de 1&#44;8&#37;&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE&#44; apesar de apresentar algum poder discriminat&#243;rio&#44; sobrestimou de forma significativa a taxa de ocorr&#234;ncia de hemorragia&#44; principalmente no grupo de doentes com <span class="elsevierStyleItalic">score</span> mais elevado&#46; Os resultados deste estudo questionam se o <span class="elsevierStyleItalic">score</span> CRUSADE dever&#225; continuar a ser considerado na estratifica&#231;&#227;o do risco hemorr&#225;gico na SCA e consequentemente serem implantadas medidas espec&#237;ficas de acordo com o seu resultado&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conflitos de interesse</span><p id="par0195" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "titulo" => "Resumo"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A hemorragia <span class="elsevierStyleItalic">major</span> &#40;HM&#41; &#233; uma complica&#231;&#227;o grave da s&#237;ndrome coron&#225;ria aguda &#40;SCA&#41; e est&#225; associada a pior progn&#243;stico&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE permite estratificar o risco de HM na SCA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a capacidade preditiva do <span class="elsevierStyleItalic">score</span> CRUSADE numa popula&#231;&#227;o contempor&#226;nea de SCA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo unic&#234;ntrico e retrospetivo com 2818 doentes admitidos por SCA&#46; O <span class="elsevierStyleItalic">score</span> CRUSADE foi calculado para cada doente&#44; a sua discrimina&#231;&#227;o e calibra&#231;&#227;o foram avaliadas pela &#225;rea abaixo da curva &#40;AUC&#41; <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> e pelo teste Hosmer&#8208;Lemeshow&#44; respetivamente&#46; Foram determinados os preditores de HM intra&#8208;hospitalar &#40;HMIH&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A taxa de HMIH foi de 1&#44;8&#37;&#44; valor significativamente inferior ao estimado pelo <span class="elsevierStyleItalic">score</span> CRUSADE &#40;7&#44;1&#37;&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A incid&#234;ncia de HMIH nas diferentes categorias foi de 0&#44;5&#37; na de muito baixo risco &#40;taxa estimada pelo <span class="elsevierStyleItalic">score</span> de 3&#44;1&#37;&#41;&#59; 1&#44;5&#37; na de baixo &#40;estimada de 5&#44;5&#37;&#41;&#59; 1&#44;6&#37; na de moderado &#40;estimada de 8&#44;6&#37;&#41;&#59; 5&#44;5&#37; na de elevado &#40;estimada de 11&#44;9&#37;&#41; e 4&#44;4&#37; na de muito elevado &#40;estimada de 19&#44;5&#37;&#41;&#46; A capacidade preditora do <span class="elsevierStyleItalic">score</span> CRUSADE para HMIH foi apenas moderada &#40;AUC 0&#44;73&#41;&#46; A taxa de mortalidade intra&#8208;hospitalar foi de 4&#44;0&#37;&#46; A idade mais avan&#231;ada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; o acesso vascular femoral &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; a frequ&#234;ncia card&#237;aca mais elevada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; e o ticagrelor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; foram preditores independentes de HMIH&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> CRUSADE&#44; apesar de apresentar algum poder discriminat&#243;rio&#44; sobrestimou de forma significativa a taxa de HMIH&#44; principalmente nos doentes de maior risco&#46; Esses resultados questionam se o <span class="elsevierStyleItalic">score</span> CRUSADE dever&#225; continuar a ser usado na estratifica&#231;&#227;o da SCA&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Major bleeding is a serious complication of acute coronary syndrome &#40;ACS&#41; and is associated with a worse prognosis&#46; The CRUSADE bleeding score is used to stratify the risk of major bleeding in ACS&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">To assess the predictive ability of the CRUSADE score in a contemporary ACS population&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">In a single&#8208;center retrospective study of 2818 patients admitted with ACS&#44; the CRUSADE score was calculated for each patient and its discrimination and goodness of fit were assessed by the area under the receiver operating characteristic curve &#40;AUC&#41; and by the Hosmer&#8208;Lemeshow test&#44; respectively&#46; Predictors of in&#8208;hospital major bleeding &#40;IHMB&#41; were determined&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">The IHMB rate was 1&#46;8&#37;&#44; significantly lower than predicted by the CRUSADE score &#40;7&#46;1&#37;&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The incidence of IHMB was 0&#46;5&#37; in the very low risk category &#40;rate predicted by the score 3&#46;1&#37;&#41;&#44; 1&#46;5&#37; in the low risk category &#40;5&#46;5&#37;&#41;&#44; 1&#46;6&#37; in the moderate risk category &#40;8&#46;6&#37;&#41;&#44; 5&#46;5&#37; in the high risk category &#40;11&#46;9&#37;&#41;&#44; and 4&#46;4&#37; in the very high risk category &#40;19&#46;5&#37;&#41;&#46; The predictive ability of the CRUSADE score for IHMB was only moderate &#40;AUC 0&#46;73&#41;&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">The in&#8208;hospital mortality rate was 4&#46;0&#37;&#46; Advanced age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#44; femoral vascular access &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#44; higher heart rate &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#41; and ticagrelor use &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41; were independent predictors of IHMB&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">The CRUSADE score&#44; although presenting some discriminatory power&#44; significantly overestimated the IHMB rate&#44; especially in patients at higher risk&#46; These results question whether the CRUSADE score should continue to be used in the stratification of ACS&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Idade&#44; anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>G&#233;nero masculino &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fatores de risco cardiovascular &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertens&#227;o arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tabagismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes pessoais &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angioplastia coron&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CABG<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfarte do mioc&#225;rdio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a vascular<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemorragia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dados cl&#237;nicos e anal&#237;ticos na admiss&#227;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sinais de insufici&#234;ncia card&#237;aca &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Frequ&#234;ncia card&#237;aca &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Press&#227;o arterial sist&#243;lica &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemat&#243;crito &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clearance creatinina &#40;mL&#47;min&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;ndrome coron&#225;ria aguda &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EAM com eleva&#231;&#227;o de ST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EAM sem eleva&#231;&#227;o de ST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EAM de localiza&#231;&#227;o indeterminada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angina inst&#225;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coronariografia &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acesso vascular radial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acesso vascular femoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ICP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Terap&#234;utica antitromb&#243;tica &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clopidogrel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ticagrelor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inibidores GP IIb&#47;IIIa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fondaparinux&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enoxaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mortalidade intra&#8208;hospitalar &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Informa&#231;&#227;o apresentada como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#47;&#8208; desvio padr&#227;o ou &#37;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0010"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Doen&#231;a vascular definida por doen&#231;a arterial perif&#233;rica ou AVC pr&#233;vio</p>"
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              "identificador" => "tblfn0015"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Clearance de creatinina estimada pela f&#243;rmula de Cockcroft&#8208;Gault</p>"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nicas da popula&#231;&#227;o</p>"
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        "identificador" => "tbl0010"
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          0 => array:3 [
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">HMIH&#58; hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar</p>"
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Observadan &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Esperada pelo <span class="elsevierStyleItalic">score</span> CRUSADE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HMIH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar observada na nossa popula&#231;&#227;o e esperada pelo <span class="elsevierStyleItalic">score</span> CRUSADE</p>"
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                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Risco de hemorragia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n2615&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hemorragia observadan &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hemorragia estimada pelo <span class="elsevierStyleItalic">score</span> CRUSADE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muito baixo &#91;1&#8208;20&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">931&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baixo &#91;21&#8208;30&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">681&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderado &#91;31&#8208;40&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">509&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevado &#91;41&#8208;50&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muito elevado &#91;&#62; 50&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2171098.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Hemorragia observada na nossa coorte <span class="elsevierStyleItalic">versu</span>s hemorragia estimada pelo <span class="elsevierStyleItalic">score</span> CRUSADE</p>"
        ]
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      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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          0 => array:3 [
            "identificador" => "at4"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">DPOC&#58; Doen&#231;a pulmonar obstrutiva cr&#243;nica&#59; FEVE&#58; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda&#59; HMIH&#58; hemorragia <span class="elsevierStyleItalic">major</span> intra&#8208;hospitalar&#59; HTA&#58; hipertens&#227;o arterial&#59; IC&#58; intervalo de confian&#231;a&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#46;</span></p>"
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem HMIH<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;766&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Com HMIH<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR n&#227;o ajustado &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade&#44; anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;65 &#40;2&#44;05&#8211;6&#44;92&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;31 &#40;1&#44;12&#8211;4&#44;76&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angina de peito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;13 &#40;1&#44;22&#8211;3&#44;72&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemorragia pr&#233;via&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;99 &#40;3&#44;87&#8211;16&#44;50&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;58 &#40;1&#44;08&#8211;6&#44;15&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neoplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;15 &#40;1&#44;91&#8211;9&#44;02&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;01 &#40;3&#44;15&#8211;8&#44;03&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobina &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;90 &#40;1&#44;06&#8211;5&#44;85&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acesso femoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;10 &#40;3&#44;39&#8211;10&#44;97&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEVE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;15 &#40;3&#44;01&#8211;8&#44;57&#41;<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enoxaparina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;49 &#40;1&#44;38&#8211;4&#44;49&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;48 &#40;1&#44;04&#8211;5&#44;92&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ticagrelor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                          "colaboracion" => "Comparison of the Global Registry of Acute Coronary Events Risk Score Versus the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse outcomes With Early Implementation of the ACC&#47;AHA Guidelines Risk Score to Predict In&#8208;Hospital Mortality and Major Bleeding in Acute Coronary Syndromes"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Manzano-Fern&#225;ndez"
                            1 => "M&#46; S&#225;nchez-Mart&#237;nez"
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                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2015.12.048"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol&#46;"
                        "fecha" => "2016"
                        "volumen" => "117"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1054"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26857164"
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                0 => array:2 [
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                    0 => array:1 [
                      "autores" => array:1 [
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                          "colaboracion" => "Bleeding in acute coronary syndromes and percutaneous coronary interventions&#58; position paper by the Working Group on Thrombosis of the European Society of Cardiology"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;G&#46; Steg"
                            1 => "K&#46; Huber"
                            2 => "F&#46; Andreotti"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehr204"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "1854"
                        "paginaFinal" => "1864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21715717"
                            "web" => "Medline"
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              "identificador" => "bib0225"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Standardized bleeding definitions for cardiovascular clinical trials&#58; a consensus report from the Bleeding Academic Research Consortium"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Mehran"
                            1 => "S&#46;V&#46; Rao"
                            2 => "D&#46;L&#46; Bhatt"
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.009449"
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                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2011"
                        "volumen" => "123"
                        "paginaInicial" => "2736"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21670242"
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                      "titulo" => "Adverse impact of bleeding on prognosis in patients with acute coronary syndromes"
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                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Eikelboom"
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                          "autores" => array:3 [
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                          "colaboracion" => "2014 AHA&#47;ACC Guideline for the management of patients with non&#8208;ST&#8208;elevation acute coronary syndromes&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force on Practice Guidelines"
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                          "colaboracion" => "Baseline risk of major bleeding in non&#8208;ST&#8208;segment&#8208;elevation myocardial infarction&#58; the CRUSADE &#40;Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC&#47;AHA Guidelines&#41; Bleeding Score"
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                      "doi" => "10.1161/CIRCULATIONAHA.108.828541"
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                      "titulo" => "CRUSADE bleeding risk score validation for ST&#8208;segment&#8208;elevation myocardial infarction undergoing primary percutaneous coronary intervention"
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                      "titulo" => "Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome"
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                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care&#46;"
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                          "colaboracion" => "2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST&#8208;segment elevation&#58; Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST&#8208;Segment Elevation of the European Society of Cardiology &#40;ESC&#41;"
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