Hot topics in the antiphospholipid syndrome

Antiphospholipid syndrome (APS) presents ongoing challenges in understanding its pathogenesis, standardizing diagnostic tests, and optimizing treatment strategies. The 18th International Congress on Antiphospholipid Antibodies (ICAPA) was held in Kyoto in September 2025. This narrative meeting wrap-up summarizes selected highlights from the Congress in seven areas, including APS pathogenesis, APS diagnostics and antiphospholipid antibodies standardization, serology and biomarkers, therapeutics, obstetric APS, organ-specific manifestations, and disease activity assessment. Topics discussed included advances in understanding antibody and antigen interactions, the distinction between classification criteria and clinical diagnosis, the clinical utility of non-criteria antibodies, anticoagulation strategies, emerging biologic therapies, the 2023 American College of Rheumatology/European Alliance of Associations for Rheumatology classification framework for obstetric APS, and approaches to disease activity monitoring. This article discusses the clinical implications of these findings and identifies future research directions. The topics covered range from preliminary to well-established. Accordingly, these findings should be interpreted cautiously, with appropriate caveats and safety considerations, and in conjunction with established clinical guidelines.