The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

doi:10.1002/art.42624

. 2023 Oct;75(10):1687-1702.

doi: 10.1002/art.42624. Epub 2023 Aug 28.

The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

Medha Barbhaiya^#¹, Stephane Zuily^#², Ray Naden³, Alison Hendry⁴, Florian Manneville⁵, Mary-Carmen Amigo⁶, Zahir Amoura⁷, Danieli Andrade⁸, Laura Andreoli⁹, Bahar Artim-Esen¹⁰, Tatsuya Atsumi¹¹, Tadej Avcin¹², H Michael Belmont¹³, Maria Laura Bertolaccini¹⁴, D Ware Branch¹⁵, Graziela Carvalheiras¹⁶, Alessandro Casini¹⁷, Ricard Cervera¹⁸, Hannah Cohen¹⁹, Nathalie Costedoat-Chalumeau²⁰, Mark Crowther²¹, Guilherme de Jesus²², Aurelien Delluc²³, Sheetal Desai²⁴, Maria De Sancho²⁵, Katrien M Devreese²⁶, Reyhan Diz-Kucukkaya²⁷, Ali Duarte-Garcia²⁸, Camille Frances²⁹, David Garcia³⁰, Jean-Christophe Gris³¹, Natasha Jordan³², Rebecca K Leaf³³, Nina Kello³⁴, Jason S Knight³⁵, Carl Laskin³⁶, Alfred I Lee³⁷, Kimberly Legault³⁸, Steve R Levine³⁹, Roger A Levy⁴⁰, Maarten Limper⁴¹, Michael D Lockshin¹, Karoline Mayer-Pickel⁴², Jack Musial⁴³, Pier Luigi Meroni⁴⁴, Giovanni Orsolini⁴⁵, Thomas L Ortel⁴⁶, Vittorio Pengo⁴⁷, Michelle Petri⁴⁸, Guillermo Pons-Estel⁴⁹, Jose A Gomez-Puerta⁵⁰, Quentin Raimboug⁵¹, Robert Roubey⁵², Giovanni Sanna⁵³, Surya V Seshan⁵⁴, Savino Sciascia⁵⁵, Maria G Tektonidou⁵⁶, Angela Tincani¹⁰, Denis Wahl², Rohan Willis⁵⁷, Cecile Yelnik⁵⁸, Catherine Zuily⁵⁹, Francis Guillemin⁵, Karen Costenbader⁶⁰, Doruk Erkan¹; ACR/EULAR APS Classification Criteria Collaborators

Collaborators, Affiliations

Collaborators

ACR/EULAR APS Classification Criteria Collaborators:
Medha Barbhaiya, Karen Costenbader, Doruk Erkan, Francis Guillemin, Alison Hendry, Florian Manneville, Ray Naden, Stephane Zuily, Mary-Carmen Amigo, Tatsuya Atsumi, Maria Laura Bertolaccini, D Ware Branch, Guilherme de Jesus, Katrien M Devreese, Camille Frances, David Garcia, Steve R Levine, Roger A Levy, Michael D Lockshin, Thomas L Ortel, Savino Sciascia, Maria G Tektonidou, Denis Wahl, Rohan Willis, Mark Crowther, Casini Alessandro, Danieli Andrade, Laura Andreoli, Bahar Artim-Esen, Tadej Avcin, Michael H Belmont, Graziela Carvalheiras, Ricard Cervera, Nathalie Costedoat-Chalumeau, Ali Duarte-Garcia, Sheetal Desai, Maria De Sancho, Reyhan Diz-Kucukkaya, Aurelien Delluc, Jean-Christophe Gris, Natasha Jordan, Rebecca K Leaf, Jason S Knight, Carl Laskin, Alfred I Lee, Kimberly Legault, Nina Kello, Maarten Limper, Karoline Mayer-Pickel, Pier Luigi Meroni, Jack Musial, Giovanni Orsolini, Vittorio Pengo, Michelle Petri, Guillermo Pons-Estel, Quentin Raimboug, Jose A Gomez Puerta, Giovanni Sanna, Surya V Seshan, Angela Tincani, Cecile Yelnik, Catherine Zuily, Zahir Amoura, Hannah Cohen, Robert Roubey, Nancy Agmon-Levin, Cassyanne Aguilar, Paula Alba, Oral Alpan, Ales Ambrozic, Luis Andrade, Simone Appenzeller, Yackov Berkun, Antonio Cabral, Guillame Canaud, Pojen Chen, Cecilia Chighizola, Rolando Cimaz, Maria Jose Cuadrado, Philip G de Groot, Philippe de Moerloose, Ronald Derksen, Thomas Dörner, Paul Fortin, Bill Giannakopoulos, Emilio B Gonzalez, Murat Inanc, Gili Kenet, Munther Khamashta, Martin Kriegel, Steven Krilis, Danyal Ladha, Patti Massicotte, Gale McCarty, Jamal Mikdashi, Barry Myones, Lisa Sammaritano, Flavio Signorelli, Arzu Soybilgic, Scott Woller, Ray Zuo

Affiliations

¹ Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
² Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France.
³ Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand.
⁴ Department of General Medicine, Middlemore Hospital, Counties Manukau Health District, Auckland, New Zealand.
⁵ CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France.
⁶ Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico DF, Mexico.
⁷ French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France.
⁸ Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil.
⁹ Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy.
¹⁰ Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey.
¹¹ Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan.
¹² Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia.
¹³ Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York.
¹⁴ Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK.
¹⁵ Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah.
¹⁶ Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
¹⁷ Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland.
¹⁸ Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain.
¹⁹ Department of Haematology, University College London, London, UK.
²⁰ Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, F-75004 Paris, France.
²¹ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
²² Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
²³ Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
²⁴ Division of Rheumatology, University of California, Irvine, California.
²⁵ Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York.
²⁶ Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, and Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
²⁷ Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey.
²⁸ Division of Rheumatology, Mayo Clinic, Rochester, Minnesota.
²⁹ Department of Dermatology-Allergology, Tenon Hospital, Paris, France.
³⁰ Department of Hematology, University of Washington, Seattle, Washington.
³¹ Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, France.
³² Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK.
³³ Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts.
³⁴ Division of Rheumatology, Northwell Health, Great Neck, New York.
³⁵ Division of Rheumatology, University of Michigan, Ann Arbor, Michigan.
³⁶ Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Canada.
³⁷ Department of Hematology, Yale School of Medicine, New Haven, Connecticut.
³⁸ Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada.
³⁹ Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York.
⁴⁰ Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, and GlaxoSmithKline, Collegeville, Pennsylvania.
⁴¹ Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands.
⁴² Department of Obstetrics, Medizinische Universität Graz, Österreich, Austria.
⁴³ Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
⁴⁴ Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.
⁴⁵ Department of Rheumatology, University Hospitals of Verona, Italy.
⁴⁶ Division of Hematology, Duke University Medical Center, Durham, North Carolina.
⁴⁷ Department of Cardiology, University Hospital, Padova, Italy.
⁴⁸ Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁴⁹ Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
⁵⁰ Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain.
⁵¹ Department of Nephrology, Bichat University Hospital, Paris, France.
⁵² Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina.
⁵³ Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁵⁴ Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
⁵⁵ Center of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy, and University of Turin, Torino, Italy.
⁵⁶ Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece.
⁵⁷ Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas.
⁵⁸ Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, F-59000 Lille, France.
⁵⁹ Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France.
⁶⁰ Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts.

^# Contributed equally.

PMID: 37635643
DOI: 10.1002/art.42624

Free article

The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

Medha Barbhaiya et al. Arthritis Rheumatol. 2023 Oct.

Free article

. 2023 Oct;75(10):1687-1702.

doi: 10.1002/art.42624. Epub 2023 Aug 28.

Authors

Collaborators

ACR/EULAR APS Classification Criteria Collaborators:
Medha Barbhaiya, Karen Costenbader, Doruk Erkan, Francis Guillemin, Alison Hendry, Florian Manneville, Ray Naden, Stephane Zuily, Mary-Carmen Amigo, Tatsuya Atsumi, Maria Laura Bertolaccini, D Ware Branch, Guilherme de Jesus, Katrien M Devreese, Camille Frances, David Garcia, Steve R Levine, Roger A Levy, Michael D Lockshin, Thomas L Ortel, Savino Sciascia, Maria G Tektonidou, Denis Wahl, Rohan Willis, Mark Crowther, Casini Alessandro, Danieli Andrade, Laura Andreoli, Bahar Artim-Esen, Tadej Avcin, Michael H Belmont, Graziela Carvalheiras, Ricard Cervera, Nathalie Costedoat-Chalumeau, Ali Duarte-Garcia, Sheetal Desai, Maria De Sancho, Reyhan Diz-Kucukkaya, Aurelien Delluc, Jean-Christophe Gris, Natasha Jordan, Rebecca K Leaf, Jason S Knight, Carl Laskin, Alfred I Lee, Kimberly Legault, Nina Kello, Maarten Limper, Karoline Mayer-Pickel, Pier Luigi Meroni, Jack Musial, Giovanni Orsolini, Vittorio Pengo, Michelle Petri, Guillermo Pons-Estel, Quentin Raimboug, Jose A Gomez Puerta, Giovanni Sanna, Surya V Seshan, Angela Tincani, Cecile Yelnik, Catherine Zuily, Zahir Amoura, Hannah Cohen, Robert Roubey, Nancy Agmon-Levin, Cassyanne Aguilar, Paula Alba, Oral Alpan, Ales Ambrozic, Luis Andrade, Simone Appenzeller, Yackov Berkun, Antonio Cabral, Guillame Canaud, Pojen Chen, Cecilia Chighizola, Rolando Cimaz, Maria Jose Cuadrado, Philip G de Groot, Philippe de Moerloose, Ronald Derksen, Thomas Dörner, Paul Fortin, Bill Giannakopoulos, Emilio B Gonzalez, Murat Inanc, Gili Kenet, Munther Khamashta, Martin Kriegel, Steven Krilis, Danyal Ladha, Patti Massicotte, Gale McCarty, Jamal Mikdashi, Barry Myones, Lisa Sammaritano, Flavio Signorelli, Arzu Soybilgic, Scott Woller, Ray Zuo

Affiliations

¹ Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
² Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France.
³ Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand.
⁴ Department of General Medicine, Middlemore Hospital, Counties Manukau Health District, Auckland, New Zealand.
⁵ CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France.
⁶ Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico DF, Mexico.
⁷ French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France.
⁸ Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil.
⁹ Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy.
¹⁰ Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey.
¹¹ Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan.
¹² Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia.
¹³ Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York.
¹⁴ Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK.
¹⁵ Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah.
¹⁶ Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
¹⁷ Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland.
¹⁸ Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain.
¹⁹ Department of Haematology, University College London, London, UK.
²⁰ Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, F-75004 Paris, France.
²¹ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
²² Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
²³ Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
²⁴ Division of Rheumatology, University of California, Irvine, California.
²⁵ Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York.
²⁶ Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, and Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
²⁷ Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey.
²⁸ Division of Rheumatology, Mayo Clinic, Rochester, Minnesota.
²⁹ Department of Dermatology-Allergology, Tenon Hospital, Paris, France.
³⁰ Department of Hematology, University of Washington, Seattle, Washington.
³¹ Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, France.
³² Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK.
³³ Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts.
³⁴ Division of Rheumatology, Northwell Health, Great Neck, New York.
³⁵ Division of Rheumatology, University of Michigan, Ann Arbor, Michigan.
³⁶ Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Canada.
³⁷ Department of Hematology, Yale School of Medicine, New Haven, Connecticut.
³⁸ Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada.
³⁹ Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York.
⁴⁰ Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, and GlaxoSmithKline, Collegeville, Pennsylvania.
⁴¹ Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands.
⁴² Department of Obstetrics, Medizinische Universität Graz, Österreich, Austria.
⁴³ Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
⁴⁴ Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.
⁴⁵ Department of Rheumatology, University Hospitals of Verona, Italy.
⁴⁶ Division of Hematology, Duke University Medical Center, Durham, North Carolina.
⁴⁷ Department of Cardiology, University Hospital, Padova, Italy.
⁴⁸ Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁴⁹ Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
⁵⁰ Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain.
⁵¹ Department of Nephrology, Bichat University Hospital, Paris, France.
⁵² Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina.
⁵³ Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁵⁴ Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
⁵⁵ Center of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy, and University of Turin, Torino, Italy.
⁵⁶ Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece.
⁵⁷ Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas.
⁵⁸ Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, F-59000 Lille, France.
⁵⁹ Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France.
⁶⁰ Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts.

^# Contributed equally.

PMID: 37635643
DOI: 10.1002/art.42624

Abstract

Objective: To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR.

Methods: This international multidisciplinary initiative included 4 phases: 1) Phase I, criteria generation by surveys and literature review; 2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; 3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and 4) Phase IV, validation using independent adjudicators' consensus as the gold standard.

Results: The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β₂ -glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 99%.

Conclusion: These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.

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References

REFERENCES

1. Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheumatol 1999;42:1309-11.
1. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost 2006;4:295-306.
1. Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med 2018;378:2010-21.
1. Sciascia S, Radin M, Cecchi I, et al. 16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome. Lupus 2021;30:1314-26.
1. Erkan D, Derksen R, Levy R, et al. Antiphospholipid Syndrome Clinical Research Task Force report. Lupus 2011;20:219-24.

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[1] Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheumatol 1999;42:1309-11.

[2] Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheumatol 1999;42:1309-11.

[3] Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost 2006;4:295-306.

[4] Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost 2006;4:295-306.

[5] Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med 2018;378:2010-21.

[6] Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med 2018;378:2010-21.

[7] Sciascia S, Radin M, Cecchi I, et al. 16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome. Lupus 2021;30:1314-26.

[8] Sciascia S, Radin M, Cecchi I, et al. 16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome. Lupus 2021;30:1314-26.

[9] Erkan D, Derksen R, Levy R, et al. Antiphospholipid Syndrome Clinical Research Task Force report. Lupus 2011;20:219-24.

[10] Erkan D, Derksen R, Levy R, et al. Antiphospholipid Syndrome Clinical Research Task Force report. Lupus 2011;20:219-24.

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The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

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The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

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