Implications of 2023 ACR/EULAR classification criteria for antiphospholipid syndrome and current diagnostic and therapeutic insights: A Delphi consensus

In 2023, new ACR/EULAR classification criteria for research on the antiphospholipid syndrome (APS) were published. This Delphi consensus paper aims to examine the implications of these criteria and to update on recent diagnostic and therapeutic insights for APS in clinical practice. A panel of 19 Dutch experts participated in two survey rounds and a final discussion to achieve agreement. Consensus was defined as a median score of ≥7, indicating strong agreement, or a score of ≤3, indicating strong disagreement. 23 of 25 statements (92%) achieved consensus. The panel concluded that the new classification criteria improve risk stratification for research purposes but are not designed for clinical diagnosis. A significant proportion of patients with obstetric APS do not fulfil these research criteria. New is the emphasis on microvascular disease. Recognizing these lesser-known APS manifestations could facilitate earlier diagnosis and improve patient outcomes. Laboratory standardization remains a significant challenge. Current treatment recommendations favor vitamin K antagonists, but direct oral anticoagulants or antiplatelet therapy may be cautiously considered in selected low-risk patients.