Antiphospholipid syndrome: the need for new international classification criteria

Introduction: As soon as the association of lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL) with thrombosis and miscarriages was described in the 1980s, the definition of the antiphospholipid syndrome (APS) became a need. Early descriptions of the disease by members of the Graham Hughes team included broad categories and unexplained laboratory inclusions. Over time, new clinical and experimental data refined the criteria, especially the obstetric manifestations, as well as the laboratory criteria. Areas covered: The authors performed a review of the literature using the PubMed database, and the following keywords were used: ‘antiphospholipid antibody’, ‘antiphospholipid syndrome’, and ‘criteria of antiphospholipid’. The history of antiphospholipid criteria, clinical and experimental advancements, and other expert opinions were included in this paper. Expert opinion: It has been 14 years since an international congress on antiphospholipid antibodies has generated new classification based on the recent extensive research performed in the field. Currently, there is a need to update the international APS classification taking into consideration the inclusion of new clinical criteria such as aPL-related nephropathy as well as new standardized antibody specificities (e.g., anti-phosphatidylserine/prothrombin antibodies) with the adoption of a standardized scoring system that can stratify APS patients.