On New Spain and Mexican medicinal botany in cardiology.

Towards the middle of the XVI century, the empirical physician Martín de la Cruz, in New Spain, compiled a catalogue of the local medicinal herbs and plants, which was translated into Latin by Juan Badiano, professor at the Franciscan college of Tlatelolco. On his side, Dr. Francisco Hernández, the royal physician (protomédico) from 1571 until 1577, performed a systematic study of the flora and fauna in this period. His notes and designs were not published at that time, but two epitomes of Hernández' works appeared, respectively, in 1615 in Mexico and in 1651 in Rome. During the XVIII century, two Spanish scientific expeditions arrived to these lands. They were led, respectively, by the Spanish naturalist Martín Sessé and the Italian seaman, Alessandro Malaspina di Mulazzo, dependent from the Spanish Government. These expeditions collected and carried rich scientific material to Spain. At the end of that century, the Franciscan friar Juan Navarro depicted and described several Mexican medicinal plants in the fifth volume of his botanic work. In the last years of the colonial period, the fundamental works of Humboldt and Bonpland on the geographic distribution of the American plants were published. In the modern age, the first research about the Mexican medicinal botany was performed in the laboratory of the Instituto Médico Nacional [National Medical Institute] under the leadership of Dr. Fernando Altamirano, who started pharmacological studies in this country. Later, trials of cardiovascular pharmacology were performed in the small laboratories of the cardiological unit at the General Hospital of Mexico City, on Dr. Ignacio Chávez' initiative. The Mexican botanical-pharmacological tradition persists alive and vigorous at the Instituto Nacional de Cardiología and other scientific institutions of the country.

Reliability of International Normalized Ratio Results in the CoaguChek Pro II System in a Clinical Setting.

The National Institute of Cardiology has previously used the CoaguChek® XS Plus system (Roche Diagnostics International Ltd), comparing capillary blood prothrombin time/international normalized ratio (PT/INR) results with those obtained using BCS-XP/Thromborel (Siemens). We assessed the reliability of PT/INR results using the third-generation CoaguChek Pro II system, the CoaguChek XS Plus system, and cobas® t 411 for citrated plasma analysis. Venous and capillary PT/INR were measured (N = 204). Spearman's correlation, Bland-Altman, and concordance analysis between methods were conducted. Spearman's correlation coefficients between venous/capillary INR were high for CoaguChek Pro II versus CoaguChek XS Plus (r = 0.994), CoaguChek Pro II versus cobas t 411 (r = 0.967), and CoaguChek XS Plus versus cobas t 411 (r = 0.968). Good concordance was observed among capillary methods (concordance coefficient [κ] = 0.888) and remaining relationships (P < .001 for all): cobas t 411 versus CoaguChek XS Plus (κ = 0.696) and cobas t 411 versus CoaguChek Pro II (κ = 0.684). In conclusion, good agreement was observed between CoaguChek Pro II, CoaguChek XS Plus, and cobas t 411.

How electricity was discovered and how it is related to cardiology.

We relate the fundamental stages of the long road leading to the discovery of electricity and its uses in cardiology. The first observations on the electromagnetic phenomena were registered in ancient texts; many Greek and Roman writers referred to them, although they provided no explanations. The first extant treatise dates back to the XIII century and was written by Pierre de Maricourt during the siege of Lucera, Italy, by the army of Charles of Anjou, French king of Naples. There were no significant advances in the field of magnetism between the appearance of this treatise and the publication of the study De magnete magneticisque corporibus (1600) by the English physician William Gilbert. Scientists became increasingly interested in electromagnetic phenomena occurring in certain fish, i.e., the so-called electric ray that lived in the South American seas and the Torpedo fish that roamed the Mediterranean Sea. This interest increased in the 18th century, when condenser devices such as the Leyden jar were explored. It was subsequently demonstrated that the discharges produced by "electric fish" were of the same nature as those produced in this device. The famous "controversy" relating to animal electricity or electricity inherent to an animal's body also arose in the second half of the 18th century. The school of thought of the physicist Volta sustained the principle of a single electrical action generated by metallic contact. This led Volta to invent his electric pile, considered as the first wet cell battery. Toward the middle of the XIX century, the disciples of the physiologist Galvani were able to demonstrate the existence of animal electricity through experiments exploring the so-called current of injury. On the path of Volta's approach, many characteristics of electricity were detailed, which ultimately led to their usage in the industrial field. The route followed by Galvani-Nobili-Matteucci led to the successes of Waller, Einthoven, etcetera, enabling the modern conquests of electro-vectorcardiography.

[On the vaccination before and after Jenner]. / La vacunación antivariólica antes y después de Jenner.

The expression "inoculation" of smallpox was first employed by doctor Emanuel Timone, native of the Greek island of Chios and graduated from the Universities of Padua and Oxford. This method was largely employed in the XVIII century. Nevertheless, in 1798, the English physician Edward Jenner published the results of his observartions and his own experience with "vaccination", i. e. the inoculation of cowpox. These were exposed in his book "Inquiry into the causes and effects of the variolae vaccinae". This method soon substituted the variolization. However it must to be mentioned that, starting from 1770, vaccination was already performed in northern Europe by non medical personnel as for example the school teacher Peter Plett. Notwithstanding some initial opposition, vaccination quickly spreaded throughout Europe. It arrived to Spain in 1801 and thence was transferred to Spanish America and Philippines Islands with the expedition leaded by doctor Francisco Xavier Balmis. This expedition reached New Spain in June 1804, and remained there until February 1805 when embarked addressing to Philippines Islands. The other expeditionary group, leaded by doctor José Salvani, addressed toward Colombia, Peru and Bolivia, where Salvani died.

Guidelines for prophylaxis and anti-thrombotic treatment for patients with COVID-19. Consensus of the Latin American Cooperative Group on Hemostasis and Thrombosis (CLAHT) / Guía de profilaxia y tratamiento antitrombótico para pacientes con COVID-19. Consenso del Grupo Cooperativo Latinoamericano en Hemostasia y Trombosis (CLAHT)

Coagulopathy and thrombosis associated with coronavirus disease 2019 (COVID-19) represent a major issue in the management of this disease. In the past months, clinical studies have demonstrated that COVID-19 patients present with a particular hypercoagulable state, in which a markedly increased D-dimer concomitant with increased levels of fibrinogen are observed. This hypercoagulable state leads to an increased risk of thrombosis, which seems to be higher among those patients with critical symptoms of COVID-19. The best therapeutic approach to prevent thrombotic events in COVID-19 has not been determined yet and several questions regarding thromboprophylaxis therapy, such as the time to initiate anticoagulation, type of anticoagulant and dose regimen, have emerged among physicians. To address these concerns, several medical societies have published position papers to provide the opinion of thrombosis experts on the management of coagulopathy and thrombosis associated with COVID-19. In line with this, the Latin America Cooperative Group of Hemostasis and Thrombosis (Grupo CLAHT) has constituted a panel of experts in thrombosis and hemostasis to discuss the available data on this topic. The aim of this review is to summarize the current evidence regarding hemostatic impairment and thrombotic risk in COVID-19 and to provide a carefully revised opinion of Latin American experts on the thromboprophylaxis and management of thrombotic events and coagulopathy in patients with suspected COVID-19.

La coagulopatía y la trombosis asociadas a la enfermedad por coronavirus 2019 (COVID-19) representan un problema importante en el manejo de esta enfermedad. Los estudios clínicos de los últimos meses han demostrado que los pacientes con COVID-19 presentan un estado de hipercoagulabilidad particular, en el que se observa un aumento notable del dímero D concomitante con niveles elevados de fibrinógeno. El estado de hipercoagulabilidad conduce a un mayor riesgo de trombosis, que parece ser mayor entre aquellos pacientes con síntomas críticos de COVID-19. El mejor enfoque terapéutico para prevenir los eventos trombóticos en esta nueva enfermedad aún no se ha determinado y han surgido varias preguntas con respecto a la tromboprofilaxia, como el momento adecuado para iniciar la anticoagulación, el tipo de anticoagulante y el régimen de dosis. Para abordar estas preocupaciones, varias sociedades médicas han publicado artículos de posición para brindar la opinión de expertos en trombosis sobre el manejo de la coagulopatía y trombosis asociadas a COVID-19. Grupo Cooperativo Latinoamericano de Hemostasia y Trombosis (Grupo CLAHT) ha convocado a un panel de expertos en trombosis y hemostasia para discutir los datos disponibles sobre este tema. El objetivo de esta revisión es resumir la evidencia actual con respecto al deterioro hemostático y el riesgo trombótico en el COVID-19 y proporcionar una opinión cuidadosamente revisada de los expertos latinoamericanos sobre la tromboprofilaxis y el manejo de eventos trombóticos y coagulopatía en pacientes con sospecha de COVID-19.

Participation of pulmonary embolism response teams during the perioperative period.

La tromboembolia pulmonar aguda representa una causa frecuente de morbimortalidad cardiovascular, sólo rebasada por los síndromes coronarios agudos y la enfermedad cerebrovascular. El inicio y la intervención de un equipo multidisciplinario de respuesta rápida en la tromboembolia pulmonar son imperantes para mejorar el pronóstico y reducir al mínimo las posibles secuelas en el subgrupo de pacientes más graves. En este artículo de revisión se describe y revisa de manera general el papel actual y potencial que tienen dichos equipos de respuesta rápida, con un enfoque particular en el perioperatorio.Acute pulmonary embolism represents a frequent cause of cardiovascular morbidity and mortality, only exceeded by acute coronary syndromes and cerebrovascular disease. The start-up and implementation of a designated pulmonary embolism response team is necessary to improve prognosis and minimize long-term sequelae in the subgroup of patients with significant pulmonary embolism. Herein, we describe and discuss an overview of the current and potential role of pulmonary embolism response teams, with a focus on the perioperative period.

[Complicaciones trombóticas en COVID-19 grave: enfoque en tromboembolia venosa, tromboprofilaxis y anticoagulación].

La enfermedad grave por coronavirus 2019 (COVID-19) está causada por el Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) y predispone a complicaciones trombóticas. En esta revisión se aborda de manera práctica la estrecha relación entre la tromboembolia venosa y la COVID-19, enfatizando aspectos epidemiológicos, factores de riesgo y tromboprofilaxis, así como potenciales opciones de anticoagulación. Actualmente la evidencia científica es muy escasa, pero día a día seguimos aprendiendo, estando atentos a cambios novedosos y dinámicos en esta enfermedad infecciosa e inmunotrombótica emergente.

[On Mexican medicinal plants]. / De la herbolaria medicinal novohispana a los inicios de estudios botánico-farmacológicos sistematizados (bosquejo histórico).

During the XVIII century, two Spanish scientific expeditions arrived here led, respectively, by the naturalist Martín Sessé and by the Italian mariner Alessandro Malaspina di Mulazzo, dependent from the Spanish Government. The members collected a rich scientific material, which was carried to Madrid in 1820. At the end of XVIII century, the Franciscan friar Juan Navarro depicted and described several Mexican medicinal plants in the fifth volume of his "American Garden". In the last years of the Colonial period, fundamental works of Humboldt and Bonpland, on the geographic distribution of the American plants, were published. At the end of the XIX century, the first researches on the Mexican medicinal botany were performed at the laboratory of the "Instituto Médico Nacional" under the leadership of doctor Fernando Altamirano, starting pharmacological studies in our country. During the first half of the XX century, trials of cardiovascular pharmacology were performed in the small laboratories of the cardiological unit at the General Hospital of Mexico, due to doctor Ignacio Chávez, initiative. Mexican botanical-pharmacological tradition remains alive and vigorous in the modern scientific institutes of the country.

Idarucizumab to revert the anticoagulant effect of dabigatran in traumatic acute subdural haematoma: a case report of first use in Latin America.

BACKGROUND: Direct oral anticoagulants (DOAC) are an attractive alternative over vitamin K antagonists. They have several advantages in primary and secondary prevention of thromboembolisms due to atrial fibrillation, as well as in prevention and treatment of thromboembolic venous disease. They have fast onset action, do not need laboratory controls in patients with normal renal function, and they have practically no interference with the patient's diet or medications. The strongest objection to their use was the lack of reversal agents that could be used in case of life-threatening haemorrhage or the need for emergency surgery. Dabigatran was the first DOAC to have its own specific reversal agent: idarucizumab, a monoclonal antibody. CASE SUMMARY: We report here the case of a patient undergoing treatment with dabigatran that suffered an expansive subdural haematoma secondary to a cranial injury. The condition was life-threatening and required emergency surgery. Anticoagulation was successfully reversed with idarucizumab. DISCUSSION: Emergency surgery in patients in treatment with DOAC is associated with an increased risk of bleeding. With the use of a specific antidote to block the action of the anticoagulant, as in the case of idarucizumab with dabigatran, the risk of complications during and after emergency surgery is reduced. This is the first case report with which the successful use of idarucizumab in Latin America is documented.

Resource Utilization and Costs Associated With Percutaneous Coronary Intervention When Treating Patients With Acute Coronary Syndrome in the Mexican National Institute of Cardiology "Ignacio Chávez".

BACKGROUND: The treatment of acute coronary syndrome (ACS) using percutaneous coronary intervention (PCI) is a frequent intervention with a high economic impact. OBJECTIVE: This study investigates the resource use and cost of PCI in Mexico where heart disease is a leading cause of death, and a large segment of the population does not have formal healthcare coverage. METHODS: This retrospective observational study obtained resource utilization data from patient files and itemized costs from the pharmacy registry at the National Institute of Cardiology. Patients were aged >18 years, diagnosed with ACS, and treated with PCI and secondary prophylaxis with aspirin plus clopidogrel or prasugrel. Patients had a follow-up of >12 months at the institute. Statistical analysis was descriptive. RESULTS: The sample included 156 patients (mean age: 58.66 years; male: 77.9%). Patients were diagnosed with ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction, and unstable angina 64.9%, 27.2%, and 7.9%, respectively. The mean (standard deviation [SD]) total medical cost was estimated to be $145 677 ($98 326) Mexican pesos 2018. The highest category of spending was surgical materials (mean [SD]: $47 834 [$32 569], comprising 32.8% of total costs); medications and access to the operating room represented 14.2% and 11.8%, respectively. Mean (SD) hospital stay was 9.07 (6.2) days; for the 11.5% of patients admitted to the intensive care unit, the mean (SD) stay was 4.61 (2.06) days. The mean cost of standard hospitalization was $12 572, or 8.6% of spending; intensive care unit hospitalization comprised 17.7% of total costs (mean: $25 802). The cost of the intervention is subsidized up to 95% for patients with a low social economic status, with the exception of surgical materials such as stents. This results in the highest burden component of the intervention being placed on the patient and not the institute. CONCLUSION: The mean cost per patient shows that PCI is an expensive procedure in Mexico. A lack of subsidies for surgical equipment places a high economic burden on the patient and represents a barrier of access for a vulnerable population that likely increases mortality and morbidity rates in those patients unable to pay for treatment and a potential high burden of debt for those who do pay.

[On human morphological studies in New Spain and in Mexico of nineteenth century]. / Acerca de los estudios morfológicos en humanos en la Nueva España y en el México decimonónico.

The renewed anatomical studies reached a culmination in the XVI century allowing the discovery of the pulmonary blood circulation and later of the systemic blood circulation. The XVII century saw the coming of microscopic anatomy and the XVIII witness the systematization of pathological anatomy. These studies will be impelled during following century toward the clinical-anatomical comparison. Regarding to America, the anatomical studies began in New Spain, when the first textbooks of anatomy, surgery and physiology were published. The first anatomy chair was established in 1621 at the Royal and Papal University of Mexico. The teaching of anatomy was modernized, making that more practical, at the Royal School of Surgery, which began to function in 1770. In the Establishment of Medical Sciences, founded in 1833, surgery was incorporated to internal medicine. This fact permitted to unify the anatomical teaching. If on examines the lists of textbooks utilized in the different periods, it comes out that these books belonged with the contemporaneous advances of science. This consideration concerns also the receptional thesis presented to Faculty of Medicine during the XIX century.

Pharmacogenetic Variation in Over 100 Genes in Patients Receiving Acenocumarol.

Coumarins are widely prescribed worldwide, and in Mexico acenocumarol is the preferred form. It is well known that despite its efficacy, coumarins show a high variability for dose requirements. We investigated the pharmacogenetic variation of 110 genes in patients receiving acenocumarol using a targeted NGS approach. We report relevant population differentiation for variants on CYP2C8, CYP2C19, CYP4F11, CYP4F2, PROS, and GGCX, VKORC1, CYP2C18, NQO1. A higher proportion of novel-to-known variants for 10 genes was identified on 41 core pharmacogenomics genes related to the PK (29), PD (3), of coumarins, and coagulation proteins (9) including, CYP1A1, CYP3A4, CYP3A5, and F8, and a low proportion of novel-to-known variants on CYP2E1, VKORC1, and SULT1A1/2. Using a Bayesian approach, we identified variants influencing acenocumarol dosing on, VKORC1 (2), SULT1A1 (1), and CYP2D8P (1) explaining 40-55% of dose variability. A collection of pharmacogenetic variation on 110 genes related to the PK/PD of coumarins is also presented. Our results offer an initial insight into the use of a targeted NGS approach in the pharmacogenomics of coumarins in Mexican Mestizos.

[Multidisciplinary meeting about the use of direct oral anticoagulants in nonvalvular atrial fibrillation]. / Reunión multidisciplinaria sobre el uso de los anticoagulantes orales directos en la fibrilación auricular no valvular.

Knowing the real impact of atrial fibrillation in the stroke, the Sociedad Mexicana of Electrofisiología y Estimulación Cardiaca (SOMEEC) had the initiative to develop a multidisciplinary meeting of experts the with the purpose to update the available scientific evidence from clinical practice guidelines, meta-analyses, controlled clinical trials, and complementing with the experience and views of a group of experts. To meet this goal, SOMEEC gathered a group of specialists in the area of cardiology, electrophysiology, neurology and hematology that given their experience in certain areas, they share the scientific evidence with the panel of experts to leave open a discussion about the information presented in this article. This document brings together the best scientific evidence available and aims to be a useful tool in the decision to use of new oral anticoagulants in nonvalvular atrial fibrillation and ischemic heart disease, or relating to the management of patients with stroke or renal failure, and even those that will be submitted to elective surgery and invasive procedures. In the same, they handled comparative schemes of follow-up and treatment which simplifies the decision making by the specialists participants.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

resumen está disponible en el texto completo

Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

[Tobacco and tobacco use disorder in the history of Mexico and Europe]. / Tabaco y tabaquismo en la historia de México y de Europa.

The tobacco used for a long time by American and Caribbean natives was introduced into Europe at the end of XV century, and essentially during the XVI century, by travelers returning to their Fatherlands. After the tobacco industry was organized, several concerns arose regarding medical and social care for the workers in the tobacco factories. Medical and hygienic aspects were reflected in a whole chapter (the XVII) of the Ramazzini's Treatise on Medicine of Work, published in 1700. Concerning social care for the workers' families, the creation, April 1796, of nursery schools for the children of working women in tobacco factories of the New Spain must be recalled. In opposition to the predictions of some natives and visitors during the last centuries, with the passage of time, the tobacco habit instead of decreasing, became progressively more accentuated in all social classes. To aggravate conditions, at present, the noxious effects of the tobacco smoke are combined with those of environmental contamination. Recent epidemiological reports on the number and health conditions of smokers, as well as the National Antitobacco Program in Mexico, are mentioned.

[Evolution of the knowledge on the blood and its movement. Part two. The knowledge about its composition. Iatrochemistry of the blood]. / Evolución del conocimiento sobre la sangre y su movimiento. Parte II. El saber sobre su composición. Iatroquímica de la sangre.

To know the composition of blood and the benefits rendered by its components to life has been a question that for centuries stimulated the curiosity of researchers. Each of the human knowledge eras has provided its own explanation and gradually contributed with a series of discoveries, which by accumulating, have allowed to explain the physiological processes of this fluid, considered like vital since the most remote times. From being one more of the four humors that constitute living matter, according to ancient medicine, blood became, during seventeenth century, a mixture of fluids and diverse particles moved incessantly by the action of the heart. Once the iatromechanical aspect of blood circulation was known, the researchers approached the problem of its composition, using the new scientific tools (observation, experimentation and measurement), such as the microscope, quantification instruments, stains and chemical reagents, that appeared during the Baroque Period and later. During seventeenth century erythocytes were discovered as well as the metallic nature of blood when iron particles were detected in it. In the eighteenth century, leukocytes were discovered and, almost a century later, platelets were added. One of the great mysteries to solve, the coagulation of the blood, began to be deciphered in the seventeenth century, when fibrin was observed in the structure of the clots. Thrombin and tissue factor was discovered during nineteenth century. At the beginnings of the twentieth century, the morphology and origin of blood cells became known, as well as their variations during some diseases. The bases for the clinical laboratory, the hematology clinic and some therapeutic procedures, such as blood transfusion, developed. Separation of plasma components, cellular identification techniques, inheritance laws, and the talent to construct instruments for ever increasing precise analyses gave rise to the numerous specialties in science that has studied the blood: Hematology, Immunology, Clinical Biochemistry, Clinical Pathology, Hemostasis and Thrombosis, Transfusional Medicine, Hematogenetics, Chemotherapy and many others.

[The centennial of blood coagulation doctrine]. / Centenario de la doctrina de la coagulación sanguínea.

For centuries, the mystery surrounding blood coagulation stimulated the curiosity of researchers. The knowledge about this function has increased notably in the last century and has permitted to understand numerous physiopatho logical phenomena in several hemorrhagic and thrombotic diseases, and has made it possible to develop diverse drugs of proved efficacy for prevention and therapy. All this was initiated in 1905, when Paul Morawitz published an extensive monograph on the four factors of blood coagulation known until then (fibrinogen, thrombin, thrombokinase, and calcium). In that work, he proposed a blood coagulation model in two stages: thrombin generation and fibrinogen coagulation. In the 1940s a true golden age in coagulation was started with the results of Quick's prothrombin time test, described in 1936, and since then the most employed coagulation test. Besides numerous factors involved in this function were discovered and classified. The discovery and introduction of heparin and coumarin in the anticoagulant therapeutics opened a measureless panorama for the arrival of new antithrombotic drugs. By the middle of the XX century, the mechanism of coagulation had been practically deciphered and diverse models based on sequential enzymatic function were proposed, called first chain reactions and in cascade reactions later. In the second half of the XX century, numerous regulatory mechanisms of coagulation were identified and diverse laboratory tests appeared that have allowed highly precise diagnoses of a variety of diseases. Blood separation techniques have permitted to produce factor concentrates for clinical use. With the identification of the genes that encode the synthesis of coagulation factors, it has been possible to produce them by means of molecular biology techniques, being the most significant the production of factors VIII, IX, and VII. The present model of coagulation is based on tissular factor activation and the participation of cells, concepts that were already implicit in the classical theory of Morawitz.

Participación de los equipos de respuesta rápida de tromboembolia pulmonar durante el perioperatorio / Participation of pulmonary embolism response teams during the perioperative period

Resumen La tromboembolia pulmonar aguda representa una causa frecuente de morbimortalidad cardiovascular, sólo rebasada por los síndromes coronarios agudos y la enfermedad cerebrovascular. El inicio y la intervención de un equipo multidisciplinario de respuesta rápida en la tromboembolia pulmonar son imperantes para mejorar el pronóstico y reducir al mínimo las posibles secuelas en el subgrupo de pacientes más graves. En este artículo de revisión se describe y revisa de manera general el papel actual y potencial que tienen dichos equipos de respuesta rápida, con un enfoque particular en el perioperatorio.

Abstract Acute pulmonary embolism represents a frequent cause of cardiovascular morbidity and mortality, only exceeded by acute coronary syndromes and cerebrovascular disease. The start-up and implementation of a designated pulmonary embolism response team is necessary to improve prognosis and minimize long-term sequelae in the subgroup of patients with significant pulmonary embolism. Herein, we describe and discuss an overview of the current and potential role of pulmonary embolism response teams, with a focus on the perioperative period.