International consensus on the prevention of venous and arterial thrombotic events in patients with inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) are at increased risk of thrombotic events. Therapies for IBD have the potential to modulate this risk. The aims of this Evidence-Based Guideline were to summarize available evidence and to provide practical recommendations regarding epidemiological aspects, prevention and drug-related risks of venous and arterial thrombotic events in patients with IBD. A virtual meeting took place in May 2020 involving 14 international IBD experts and 3 thrombosis experts from 12 countries. Proposed statements were voted upon in an anonymous manner. Agreement was defined as at least 75% of participants voting as 'fully agree' or 'mostly agree' with each statement. For each statement, the level of evidence was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) grading system. Consensus was reached for 19 statements. Patients with IBD harbour an increased risk of venous and arterial thrombotic events. Thromboprophylaxis is indicated during hospitalization of any cause in patients with IBD. Disease activity is a modifiable risk factor in patients with IBD, and physicians should aim to achieve deep remission to reduce the risk. Exposure to steroids should be limited. Antitumour necrosis factor agents might be associated with a reduced risk of thrombotic events

Toward harmonized interpretation of anticardiolipin and anti-β2-glycoprotein I antibody detection for diagnosis of antiphospholipid syndrome using defined level intervals and likelihood ratios : communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies

Background: Improving harmonization of the clinical interpretation of anticardiolipin (aCL) and anti-beta-2-glycoprotein I (aB2GPI) antibodies immunoglobulin G (IgG)/immunoglobulin M (IgM) in the diagnosis of antiphospholipid syndrome (APS) is desirable. Likelihood ratios (LRs) with corresponding test-result intervals can identify the power of a test to discriminate between a diseased and nondiseased patient and may be useful for the semiquantitative interpretation of aCL/aB2GPI results. Objectives: To determine moderate and high thresholds for aCL and aB2GPI IgG/IgM measured with chemiluminescent immunoassay, enzyme-linked immunosorbent assay, fluorescence enzyme immunoassay, and multiplex flow immunoassay. Methods: aCL and aB2GPI antibodies IgG/IgM were determined with 4 solid-phase systems in a case-control study population including 381 APS patients and 727 controls. Interval-specific LRs (IS-LR) were calculated for ranges determined by prespecified specificity and sensitivity levels. Three methods were used for determining thresholds that separated low, moderate, and high positive antibody levels. Interassay agreement was checked with Cohen's kappa statistics. Results: Assay- and antibody-specific thresholds demonstrated increasing IS-LR, reflecting different clinical significance for low, moderate, and high levels, especially for IgG aCL and aB2GPI and in thrombotic APS. IS-LRs per antibody and unit range were comparable across solid-phase platforms resulting in enhanced harmonization of result interpretation. Agreement between assays for identifying high levels was improved by semiquantitative interpretation compared with that by quantitative reporting. Conclusion: aCL and aB2GPI IgG/IgM moderate and high thresholds were determined for 4 analytical platforms. Thresholds improve harmonized interpretation of aCL/ aB2GPI levels across platforms. The proposed thresholds should be verified in an independent case-control study to check interlaboratory transferability

Manual versus automatic chest compression devices for cardiopulmonary resuscitation under zero gravity (The MACCC -OG study)

International audienceIntroduction: Cardiopulmonary resuscitation (CPR) in microgravity requires specific methods to counteract weightlessness. Automatic chest com- pression devices (ACCDs) could improve CPR in microgravity. We aimed to compare ACCDs versus manual CPR in microgravity simulated through parabolic flights.Methods: This prospective, open, controlled study compared 3 ACCDs (LUCAS 3©, AUTOPULSE©, EASYPULSE©) to manual CPR during the 66th CNES (Centre National d’Etudes Spatiales) parabolic flights campaign onboard the Novespace Air Zero-G A310 aircraft. Chest compression depths and rates were monitored by a Laerdal© Resusci-Ann-QCPR manikin.Results: The LUCAS 3© device had a median compression depth of 53.0 [53.0–54.0] mm, significantly higher than the EASYPULSE©, AUTOPULSE©, and Manual CPR (Handstand method), measured at 29.0 [26.0–32.0] mm, 29.0 [27.5–30.7] mm and 34.5 [29.6–43.3] mm, respectively (p value < 0.001). Compression rates were 101 [101–101], 100 [100–100] and 80 [80–80] compressions per minute (cpm) for the LUCAS 3©, EASY- PULSE©, and AUTOPULSE©, respectively. Manual CPR provided a significantly higher compression rate with 115 [109–123] cpm (p value < 0.001).Conclusion: Only LUCAS 3© provided effective CPR according to international guidelines. ACCDs should implement microgravity CPR algorithms

Manual versus automatic chest compression devices for cardiopulmonary resuscitation under zero gravity (The MACCC -OG study)

International audienceIntroduction: Cardiopulmonary resuscitation (CPR) in microgravity requires specific methods to counteract weightlessness. Automatic chest com- pression devices (ACCDs) could improve CPR in microgravity. We aimed to compare ACCDs versus manual CPR in microgravity simulated through parabolic flights.Methods: This prospective, open, controlled study compared 3 ACCDs (LUCAS 3©, AUTOPULSE©, EASYPULSE©) to manual CPR during the 66th CNES (Centre National d’Etudes Spatiales) parabolic flights campaign onboard the Novespace Air Zero-G A310 aircraft. Chest compression depths and rates were monitored by a Laerdal© Resusci-Ann-QCPR manikin.Results: The LUCAS 3© device had a median compression depth of 53.0 [53.0–54.0] mm, significantly higher than the EASYPULSE©, AUTOPULSE©, and Manual CPR (Handstand method), measured at 29.0 [26.0–32.0] mm, 29.0 [27.5–30.7] mm and 34.5 [29.6–43.3] mm, respectively (p value < 0.001). Compression rates were 101 [101–101], 100 [100–100] and 80 [80–80] compressions per minute (cpm) for the LUCAS 3©, EASY- PULSE©, and AUTOPULSE©, respectively. Manual CPR provided a significantly higher compression rate with 115 [109–123] cpm (p value < 0.001).Conclusion: Only LUCAS 3© provided effective CPR according to international guidelines. ACCDs should implement microgravity CPR algorithms

Added value of antiphosphatidylserine/prothrombin antibodies in the workup of obstetric antiphospholipid syndrome : communication from the ISTH SSC subcommittee on lupus anticoagulant/antiphospholipid antibodies

Background: The added value of antiphosphatidylserine/prothrombin antibodies (aPS/ PT) in the diagnostic workup of antiphospholipid syndrome (APS) is unclear. Currently, diagnosis of thrombotic APS (TAPS) and obstetric APS (OAPS) requires persistent presence of lupus anticoagulant (LAC), anticardiolipin (aCL) immunoglobulin (Ig) G/IgM, or anti-beta 2- glycoprotein I (a beta 2GPI) IgG/IgM antibodies. Objectives: To evaluate the role of aPS/PT IgG and IgM in OAPS. Methods: aPS/PT IgG/IgM, aCL IgG/IgM, a beta 2GPI IgG/IgM, and LAC were determined in 653 patients (OAPS, TAPS, and controls). In-house aPS/PT cut-off values were calculated, titers and prevalence were compared between OAPS, TAPS, and controls and type of pregnancy morbidity. Sensitivity, specificity, likelihood ratios, and odds ratios (OR) with 95% CI were calculated. Results: In OAPS, aPS/PT IgG and IgM showed an OR of 4.32 (95% CI, 2.54-7.36) and 3.37 (95% CI, 1.93-5.89), respectively, but the association was not independent of LAC. Prevalence and titers of aPS/PT IgG and IgM were lower in OAPS than in patients with TAPS. aPS/PT were more prevalent and showed higher titers in patients with late pregnancy loss than in patients with early pregnancy loss with a positivity of 86.4% and 39.3%, respectively. Higher aPS/PT titers did not increase the likelihood of having OAPS. Conclusion: The added value of aPS/PT testing in the current diagnostic workup of OAPS seems limited compared with LAC, aCL, and a beta 2GPI. aPS/PT might be useful in specific subsets of patients with OAPS. However, future multicentric studies are needed to elucidate the risk of less frequent and most severe obstetrical manifestations

Efforts to Better Characterize "Antiphospholipid Antibody Nephropathy" for the 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria: Renal Pathology Subcommittee Report

Objective Antiphospholipid antibody (aPL) nephropathy (-N) can be challenging to recognize due to a lack of established classification or diagnostic criteria. As part of efforts to develop new antiphospholipid syndrome (APS) classification criteria (CC), the APS CC Renal Pathology Subcommittee aimed to better characterize the entity of aPL-N. Methods We used a 4-pronged approach that included (1) administering Delphi surveys to worldwide APS physicians to generate aPL-N terminology; (2) conducting a literature review to demonstrate the association of nephropathy with aPL and identify published aPL-N histopathological terminology and descriptions; (3) evaluating aPL-N terminology used in renal biopsy reports from an international patient registry; and (4) evaluating proposed kidney pathologic features for aPL-N by assessment of international Renal Pathology Society (RPS) members. Results After completing our metaanalysis demonstrating an association between nephropathy and aPL, we used Delphi surveys, a literature review, and international renal biopsy reports to develop a preliminary definition of aPL-N. The preliminary definition included include specific terms associated with acute (ie, thrombotic microangiopathy in glomeruli or arterioles/arteries) and chronic (ie, organized arterial or arteriolar microthrombi with or without recanalization, organized glomerular thrombi, fibrous and fibrocellular [arterial or arteriolar] occlusions, focal cortical atrophy with or without thyroidization, and fibrous intimal hyperplasia) lesions. Most RPS survey respondents agreed with this terminology and the importance of knowing aPL results for histopathological diagnosis. Conclusion Our results support the inclusion of aPL-N in the 2023 American College of Rheumatology/European Alliance of Associations for Rheumatology APS CC, and provide the most widely accepted terminology to date for both acute and chronic pathologic lesions of aPL-N.SCOPUS: ar.jinfo:eu-repo/semantics/publishe