Sharper definitions, blurred lines: The clinical aftermath of the revised antiphospholipid syndrome criteria

The revised criteria for antiphospholipid antibody syndrome (APS) proposed in 2023 by the American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) 1 have introduced a conundrum in the diagnosis and management of affected patients, particularly those with a history of obstetric APS. An increasingly common challenge is the management of patients who met the 2006 Sapporo criteria for obstetric APS and were managed accordingly with anticoagulation and aspirin in a prior pregnancy, but with the same laboratory and clinical history do not meet the 2023 criteria for a subsequent pregnancy. Whether to continue management based on the old criteria versus to inform the patients they no longer have the disease or indication for active management is an increasingly posed question without a definitive data ‐ supported answer.