Antiphospholipid syndrome: looking for a refocusing

The antiphospholipid syndrome (APS) is characterised by thrombotic or obstetric symptoms associated with persistent antiphospholipid antibodies (aPL). Despite an increasing standardisation of aPLs testing, which is prone to strong evolutions due to brilliant progresses in the understanding of APS pathophysiology, the specificity and sensitivity of the epidemiological associations between symptoms and aPLs are highly variable, with persistent strong equivocal evidences probably leading to over-diagnosis, particularly in the obstetrical presentations where consistent association studies are rare and levels of evidence limited. We propose to review the APS definition based on biological mechanisms, to abandon the clinical syndromes which are still molecularly unclassified like "unexplained recurrent pregnancy losses before week 10" and the aspecific markers like classic anticardiolipin antibodies, and finally to narrow APS criteria asa constructive promise for a determined move toward precision medicine.