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Evangelista Masip A, López-Sainz Á, Barros Membrilla AJ, Calvo Iglesias F, López Ayerbe J, Azqueta Molluna M, Mosquera Rodríguez VX, Arregui Montoya F, Tarrío Fernández R, Revilla Orodea A, Sánchez Sánchez V, Cantero Pérez EM, Ferrera C, Toral Sepúlveda D, Nistal F, Fernández Golfín C, Sao A, Rodríguez-Palomares J. Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome. Rev Esp Cardiol (Engl Ed) 2022; 75:816-824. [PMID: 35527170 DOI: 10.1016/j.rec.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. METHODS We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). RESULTS AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. CONCLUSIONS The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.
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Affiliation(s)
| | - Ángela López-Sainz
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Jordi López Ayerbe
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Francisco Arregui Montoya
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Ana Revilla Orodea
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Carlos Ferrera
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - David Toral Sepúlveda
- Servei de Cirurgia Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Nistal
- Servicio de Cirugía Cardiaca, Hospital Universitario Valdecilla, Santander, Spain
| | | | - Augusto Sao
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Navarro-Almenzar B, Cerezo-Manchado JJ, Caro-Martinez C, García-Candel F, Flores Blanco PJ, Ruiz GE, Andreu Cayuelas JM, Montoya FA, Cascales A, Lova Navarro A, García Alberola A, Andrés Pascual Figal D, Bailen Lorenzo JL, Manzano-Fernández S. Real-life behaviour of direct oral anticoagulants in a Spanish cohort with non-valvular atrial fibrillation: Refase Registry. Curr Med Res Opin 2019; 35:2035-2041. [PMID: 31335222 DOI: 10.1080/03007995.2019.1647735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aim: To analyse the effectiveness and safety of DOAC (direct oral anticoagulants) in non-valvular atrial fibrillation (NVAF) patients attending clinical practice.Methods: Retrospective study of AF patients who started treatment with DOAC from January 1, 2013 to December 31, 2016 in three Spanish hospitals. Mean follow-up was 1.6 years. The primary outcomes were rates of all-cause death, ischaemic stroke, and bleeding. These outcomes were also studied depending on correct dosage adjustment and standard/adjusted dose.Results: The study included 2494 patients (age = 76.0 ± 9.5 years, CHA2DS2-VASc = 4.0 ± 1.6). The most prescribed DOAC was rivaroxaban (41.1%). Patients taking dabigatran were the youngest (mean age = 73.1 ± 10.3 years), with better kidney function (mean CrCl = 80.6 ± 35.8 ml/min) and lower CHA2DS2-VASc (3.7 ± 1.4) and HAS-BLED (2.1 ± 0.9) scores. Patients taking apixaban were the oldest, and had the highest CHA2DS2-VASc and HAS-BLED scores (4.3 ± 1.6 and 2.6 ± 0.9, respectively). Rates of stroke/major bleeding/intracranial bleeding were 1.8/3.0/0.3 events per 100 patient-years, respectively, with no differences among DOAC. Based on dose adjustment according to technical data, it was observed that 517 patients (23.5%) received DOAC doses inconsistent with labelling (p < .001) and, within this group, under-dosed patients had a higher death rate although it did not reach a significant result after multivariate adjustment.Conclusions: The results of safety and efficacy are very similar to those of other previously published national registries. There were no differences among the different types of DOAC regarding outcomes. However, it was found that people taking the adjusted dose of the drug seemed to have a higher risk of death. A non-negligible proportion of patients received DOAC doses inconsistent with labelling (mostly underdose).
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Affiliation(s)
- Begoña Navarro-Almenzar
- Servicio de Hematología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Juan José Cerezo-Manchado
- Servicio de Hematología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - César Caro-Martinez
- Servicio de Cardiología, Hospital Vega Baja, Orihuela, Alicante, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Faustino García-Candel
- Servicio de Hematología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Pedro José Flores Blanco
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Ginés Elvira Ruiz
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - José Miguel Andreu Cayuelas
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Francisco Arregui Montoya
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Almudena Cascales
- Servicio de Hematología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Alejandro Lova Navarro
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Arcadio García Alberola
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | - Domingo Andrés Pascual Figal
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
| | | | - Sergio Manzano-Fernández
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, El Palmar, Spain
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Caro Martínez C, Elvira Ruiz G, Flores Blanco PJ, Cerezo Manchado JJ, Albendín Iglesias H, Lova Navarro A, Arregui Montoya F, García Alberola A, Pascual Figal DA, Bailén Lorenzo JL, Manzano Fernández S. Prevalence and Prognostic Implications of Valve Disease in Patients With Atrial Fibrillation Initiating Direct Oral Anticoagulants. Rev Esp Cardiol (Engl Ed) 2019; 72:935-943. [PMID: 30497945 DOI: 10.1016/j.rec.2018.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/09/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Valvular heart disease in patients with atrial fibrillation included in clinical trials with direct oral anticoagulants (DOAC) is common and is associated with worse prognosis. The aim of this study was to evaluate the prevalence of valvular heart disease and its influence on clinical events in real-world clinical practice. METHODS We conducted a retrospective multicenter registry including 2297 consecutive patients with nonvalvular atrial fibrillation initiating DOAC between January 2013 and December 2016. Valvular heart disease was defined as moderate or severe involvement. The primary study endopoint was the composite of death, stroke or transient ischemic attack/systemic embolism or major bleeding. A competing risks analysis was carried out using a Fine and Gray regression model, with death being the competing event. RESULTS A total of 499 (21.7%) patients had significant valvular heart disease. The most common form was mitral regurgitation (13.7%). Patients with valvular heart disease were older and had more comorbidities. After multivariable analysis, valvular heart disease was associated with a higher risk for the primary endpoint (HR, 1.54; 95%CI, 1.22-1.94; P<.001), death (HR, 1.44; 95%CI, 1.09-1.91, P=.010), and major bleeding (HR, 1.85; 95%CI, 1.23-2.79, P=.003), but there was no association with thromboembolic events (P >.05). CONCLUSIONS In patients with nonvalvular atrial fibrillation initiating DOACs, valvular heart disease is common and increases the risk of mortality, stroke, transient ischemic attack/systemic embolism, and major bleeding complications. These findings confirm the results of clinical trials and expand them to a real-life clinical setting.
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Affiliation(s)
- César Caro Martínez
- Servicio de Cardiología, Hospital Vega Baja, Orihuela, Alicante, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Ginés Elvira Ruiz
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Pedro J Flores Blanco
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Juan José Cerezo Manchado
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Helena Albendín Iglesias
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Alejandro Lova Navarro
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Francisco Arregui Montoya
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Arcadio García Alberola
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Domingo Andrés Pascual Figal
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | | | - Sergio Manzano Fernández
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain.
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Elvira Ruiz G, Caro Martínez C, Flores Blanco PJ, Cerezo Manchado JJ, Albendín Iglesias H, Lova Navarro A, Arregui Montoya F, García Alberola A, Pascual Figal DA, Bailén Lorenzo JL, Manzano-Fernández S. Effect of concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating non-vitamin K antagonists. Eur J Clin Invest 2019; 49:e13161. [PMID: 31449685 DOI: 10.1111/eci.13161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Antiplatelet therapy (APT) use in combination with oral anticoagulation is common among patients with atrial fibrillation, but there is scarce information regarding its effect on outcomes in patients on non-vitamin K antagonist oral anticoagulants (NOAC). We aimed to evaluate the safety and efficacy of APT use in a 'real-world' cohort of nonvalvular atrial fibrillation (NVAF) patients initiating NOAC. DESIGN We conducted a retrospective multicentre study including 2361 consecutive NVAF patients initiating NOAC between January 2013 and December 2016. Patients with an acute ischaemic event within the last 12 months (acute coronary syndrome, stroke or revascularization) were excluded. Patients were followed up, and all clinical events were recorded at 3 months. The primary outcome of the study was major bleeding, and the secondary outcomes were stroke, nonfatal myocardial infarction, intracranial bleeding and death. RESULTS One hundred forty-five (6.1%) patients received concomitant APT, and aspirin was the more common (79%). At 3 months, 25 (1.1%) patients had major bleeding, 8 (0.3%) had nonfatal myocardial infarction, 7 (0.3%) had ischaemic stroke, and 40 (1.7%) died. After multivariate adjustment, concomitant APT was associated with higher risk for major bleeding (HR = 3.62, 95% CI 1.32-9.89; P = .012), but was not associated with a higher risk of other clinical outcomes. CONCLUSIONS Concomitant APT use is uncommon among these patients and does not seem to be associated with lower rates of ischaemic events or death. However, there are signals for an increased risk of bleeding, which reinforces current guideline recommendations.
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Affiliation(s)
- Ginés Elvira Ruiz
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - César Caro Martínez
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain.,Department of Cardiology, University Hospital Morales Meseguer, Murcia, Spain
| | - Pedro J Flores Blanco
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Juan José Cerezo Manchado
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain.,Department of Hematology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Helena Albendín Iglesias
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain.,Department of Internal Medicine, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Alejandro Lova Navarro
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Francisco Arregui Montoya
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Arcadio García Alberola
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain.,School of Medicine, University of Murcia, Murcia, Spain
| | - Domingo A Pascual Figal
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain.,School of Medicine, University of Murcia, Murcia, Spain
| | | | - Sergio Manzano-Fernández
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain.,School of Medicine, University of Murcia, Murcia, Spain
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Caro Martinez C, Cerezo Manchado JJ, Flores Blanco PJ, Elvira Ruíz G, Albendín Iglesias H, Lova Navarro A, Arregui Montoya F, García Alberola A, Andrés Pascual Figal D, Bailén Lorenzo JL, Navarro-Almenzar B, García-Candel F, Manzano Fernández S. Effectiveness and safety of rivaroxaban in nonvalvular atrial fibrillation: data from a contemporary Spanish registry. Curr Med Res Opin 2019; 35:1463-1471. [PMID: 30912682 DOI: 10.1080/03007995.2019.1600483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: To ascertain the clinical profile, management and rates of thromboembolic and bleeding complications in a contemporary cohort of patients with nonvalvular atrial fibrillation (NVAF) on rivaroxaban treatment, with a particular focus on some subgroups of patients. Methods: Retrospective study that included all NVAF patients who started treatment with rivaroxaban for the prevention of stroke or systemic embolism between December 2012 and December 2015. Rates of outcomes (stroke, nonfatal myocardial infarction, major bleeding, intracranial bleeding and death) during follow-up were calculated. Results: A total of 732 patients (mean age 76.4 ± 9.2 years; 54.5% women) were included. Comorbidities were common (hypertension 87.5%; diabetes 26.5%; renal insufficiency 24.6%; prior stroke/transient ischemic attack 16.8%). Mean CHA2DS2-VASc was 3.9 ± 1.5 and HAS-BLED 2.3 ± 0.9; 61.9% of patients were rivaroxaban naïve users. After a mean treatment period of 22.7 ± 7.4 months, rates of stroke, nonfatal myocardial infarction, major bleeding, intracranial bleeding and death were 1.8, 1.0, 3.2, 0.4 and 5.5 events per 100 patient-years, respectively. Rates of stroke and death were higher in patients >75 years (vs. ≤75 years) and in patients with prior stroke/transient ischemic attack or renal insufficiency. Rates of major bleeding were higher among patients >75 years and in patients with prior stroke/transient ischemic attack. Conclusions: In this contemporary Spanish cohort of NVAF patients on rivaroxaban, patients had many comorbidities, a high thromboembolic risk and a moderate bleeding risk. Overall, rates of stroke and bleeding complications were low and similar to other previous studies. These data suggest that rivaroxaban is effective and safe in routine practice.
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Affiliation(s)
| | - Juan José Cerezo Manchado
- b Servicio de Hematología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
| | - Pedro José Flores Blanco
- c Servicio de Cardiología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
| | - Ginés Elvira Ruíz
- c Servicio de Cardiología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
| | - Helena Albendín Iglesias
- d Departamento de Medicina Interna, Facultad de Medicina , Universidad de Murcia , Spain
- e Servicio de Medicina Interna , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
| | - Alejandro Lova Navarro
- c Servicio de Cardiología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
| | - Francisco Arregui Montoya
- c Servicio de Cardiología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
| | - Arcadio García Alberola
- c Servicio de Cardiología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
- d Departamento de Medicina Interna, Facultad de Medicina , Universidad de Murcia , Spain
- f Instituto Murciano de Investigación Biosanitaria , El Palmar , Spain
| | - Domingo Andrés Pascual Figal
- c Servicio de Cardiología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
- d Departamento de Medicina Interna, Facultad de Medicina , Universidad de Murcia , Spain
- f Instituto Murciano de Investigación Biosanitaria , El Palmar , Spain
| | | | - Begoña Navarro-Almenzar
- b Servicio de Hematología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
| | - Faustino García-Candel
- b Servicio de Hematología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
- f Instituto Murciano de Investigación Biosanitaria , El Palmar , Spain
| | - Sergio Manzano Fernández
- c Servicio de Cardiología , Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar , Spain
- d Departamento de Medicina Interna, Facultad de Medicina , Universidad de Murcia , Spain
- f Instituto Murciano de Investigación Biosanitaria , El Palmar , Spain
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