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Cited by 7Systemic Lupus Erythematosus ResearchVasculitis and related conditionsSystemic Sclerosis and Related Diseases

Insights into the 2023 ACR/EULAR antiphospholipid syndrome classification criteria: findings from a cohort of 205 patients with primary APS

Open access
Zen, Margherita, Tonello, Marta, Carta, Francesco, Calligaro, Antonia, Favaro, Maria, Del Ross, Teresa, Hulej, Greta, Rahmé, Zahrà +2 more·2025·Rheumatology
DOI 10.1093/rheumatology/keae665PMC PMC12212896
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Abstract

Objectives: The 2023 American College of Rheumatology / European Alliance of Associations for Rheumatology (ACR/EULAR) antiphospholipid syndrome (APS) classification criteria distinguish between anticardiolipin (aCL) or anti-β2-glycoprotein I (aβ2GPI) IgG vs IgM isotypes, having isolate IgM positivity a low weight, insufficient for APS classification, and define aCL and aβ2GPI thresholds based on fixed cut-off values. We aimed to assess the performance of the 2023 ACR/EULAR criteria in a cohort of primary vascular APS patients (PAPS), previously classified according to the Sydney criteria. Additionally, we evaluated the risk of thrombotic recurrence in patients re-classified or not according to the new criteria. Methods: PAPS patients meeting the Sydney criteria with previous vascular manifestations followed between 1992 and 2023 were re-evaluated to identify cases that would not be classified as PAPS based on the 2023 ACR/EULAR criteria. Results: Our cohort included 205 PAPS patients: 171 met the ACR/EULAR classification criteria, 34 (16.6%) did not due to insufficient score in the laboratory domain caused by isolate IgM positivity (23 patients) or aPL positivity at a titer >99th percentile but <40 units (11 patients). Notably, 9/34 (26%) patients not confirmed as PAPS had a thrombotic relapse during follow-up. The rate of thrombotic recurrence was similar between patients who fulfilled or not the new criteria. Conclusion: Among PAPS patients classified by Sydney criteria, 16.6% did not meet 2023 ACR/EULAR criteria. One quarter of them had a thrombotic relapse, confirming a pro-thrombotic profile. Inappropriately using these criteria as diagnostic in clinical practice could result in the lack of adequate antithrombotic therapy, exposing these patients to the risk of a new thrombotic event.

AI snapshot

Written from the paper’s full text.

TL;DR

In 205 primary vascular APS patients meeting Sydney criteria, 171 (83.4%) met the 2023 ACR/EULAR criteria and 34 (16.6%) did not, mostly because of isolated IgM positivity or aPL titers >99th percentile but <40 units. Thrombotic recurrence was similar between groups, and 9/34 (26%) non-classified patients relapsed, suggesting the new criteria may exclude some high-risk patients.

Key findings

  • The 2023 ACR/EULAR criteria classified 171/205 (83.4%) Sydney-classified PAPS patients; 34/205 (16.6%) were not classified. Reasons were isolated IgM positivity in 23/34 (67.6%) and aPL titer <40 units but >99th percentile in 11/34 (32.4%).
  • Non-classified patients were older at first thrombotic event (49.5 ± 12.1 vs 42.2 ± 14.2 years, P = 0.004) and had different antibody profiles: triple positivity was 125/171 (73.1%) in classified vs 2/34 (5.9%) in non-classified, and LA was 139/171 (81.3%) vs 2/34 (5.9%) (both P < 0.001).
  • 9/34 (26%) non-classified patients had a thrombotic relapse during follow-up. After excluding three provoked recurrences, recurrence rates were 8.8% (14/171) in classified patients vs 18.8% (6/34) in non-classified patients, reported as similar (P = 0.08 in Table 2).

Methods

  • Retrospective cohort study of prospectively collected data from 205 PAPS patients with previous arterial, venous, or small-vessel thrombosis who met Sydney criteria, followed at the Padua University Hospital Rheumatology Unit between 1992 and 2023; patients with exclusive pregnancy morbidity were excluded.
  • Patients were re-evaluated against the 2023 ACR/EULAR APS classification criteria. aCL and aβ2GPI were detected by ELISA; LA was assessed by a three-step procedure. Cut-offs for medium-to-high aCL/aβ2GPI were calculated as >99th percentile using sera from 120 healthy blood donors.
  • Analyses compared patients classified vs not classified by the 2023 criteria and assessed thrombotic recurrence; continuous variables used t test or Mann–Whitney test, categorical variables used χ2 test with Fisher’s correction for samples <5.

Limitations

  • Stated by the paper: no control group to assess specificity and accuracy of the new criteria; exclusion of pregnancy-related morbidity reduces generalizability; data were analyzed retrospectively; follow-up duration varied between patients, potentially affecting thrombotic relapse risk and comparability.
  • Evident from the text: single-center observational cohort, and the study evaluates classification criteria performance rather than diagnostic accuracy in routine practice.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/rheumatology/keae665

Cites

13 of 13 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 18 cited sources checked · 5 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    The 2023 ACR/EULAR criteria improved specificity in classifying patients with APS compared with Sydney criteria.

    “In fact, the 2023 ACR/EULAR criteria improved specificity in classifying patients with APS compared with Sidney criteria [1].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [1] Barbhaiya, 2023, ACR/EULAR antiphospholipid syndrome classification criteria, Ann Rheum Dis source
  • Findingown data

    Exclusive positive IgM isotype was a reason for discrepancy in classification in 23 patients (67.6%).

    “Reasons for the discrepancy in classification were: (i) exclusive positive IgM isotype in 23 patients (67.6%), and (ii) aPL titer lower than 40 units, but >99th percentile in 11 patients (32.4%).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.
  • Findingown data

    Single positivity was more frequent in unclassified (35.3%) than classified (10.5%) patients.

    “| Single positivity | 18 (10.5) | 12 (35.3) | <0.001 |”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.
  • Findingown data

    Of 205 PAPS patients, 171 (83.4%) met the 2023 ACR/EULAR classification criteria.

    “Of them, 171 patients (83.4%) met the 2023 ACR/EULAR classification criteria, while 34 (16.6%) did not.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.
  • Findingown data

    Unclassified patients more frequently had a high-risk profile for venous thrombosis (9.4% vs 0.6%, P = 0.004).

    “and more frequently had a high-risk profile for venous thrombosis, as defined in the ACR/EULAR classification criteria (9.4% vs 0.6%, P = 0.004)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.
  • Classified as probably not a substantial claim. 13
  • May combine two claims. 15

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    No data support the use of fixed cut-off values.

    “although no data support the use of fixed cut-off values [6, 7].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [6] Vandevelde, 2022, Semiquantitative interpretation of anticardiolipin and anti-β2glycoprotein I antibodies measured with various analytical platforms: communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies, J Thromb Haemost source

      The conclusion (Additional information; page not provided) says the study demonstrated that fixed thresholds of 40 and 80 units are acceptable for aCL IgG and anti-β2GPI IgG measured by ELISA. It cautions that those thresholds cannot be applied to CLIA or MFI platforms, but that is narrower than the claim that no data support fixed cut-offs at all. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [7] Ruffatti, 2008, Influence of different IgG anticardiolipin antibody cut-off values on antiphospholipid syndrome classification, J Thromb Haemost source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The choice of 40 units as the cut-off is questionable.

    “In addition, as pinpointed by other authors [3, 4], the choice of 40 units as the cut-off is questionable.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [3] Huisman, 2024, Antiphospholipid solid phase based assays: problems and proposed solutions for the 2023 ACR/EULAR classification criteria for antiphospholipid syndrome, J Thromb Haemost source
    • cites [4] Miro-Mur, 2024, Correspondence on ‘2023 ACR/EULAR antiphospholipid syndrome classification criteria’, Ann Rheum Dis source

  • May combine two claims.

    Interpretationcitation

    Patients with both traditional risk factors and positive aPL are at increased risk of thrombosis, although they do not fulfil classification criteria.

    “these patients with both traditional risk factors and positive aPL are at increased risk of thrombosis. This increased risk should be acknowledged by clinicians, although patients do not fulfil classification criteria [11].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [11] Foddai, 2024, 2023 ACR/EULAR classification criteria in existing research cohorts: an international study, Rheumatology (Oxford) source

      The Impact of 2023 ACR/EULAR criteria for APS section reports aPL-positive patients with cardiovascular risk factors and prior thrombotic events who did not meet the new classification criteria. It does not establish that having both risk factors and positive aPL increases thrombosis risk relative to a comparison group. The Discussion cautions that classification criteria should not determine treatment decisions. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The distinction between moderate (40-79 units) and high (≥80 units) positivity would be of little value.

    “in this context, the distinction between moderate (40–79 units) and high (≥80 units) positivity would be of little value.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] Miro-Mur, 2024, Correspondence on ‘2023 ACR/EULAR antiphospholipid syndrome classification criteria’, Ann Rheum Dis source

  • Classified as probably not a substantial claim.

    Premisecitation

    The 2023 ACR/EULAR criteria define aCL and aβ2GPI thresholds as moderate (40-79 units) and high positivity (>80 units).

    “Moreover, the aCL and aβ2GPI thresholds were defined as moderate (40–79 units) and high positivity (>80 units)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [1] Barbhaiya, 2023, ACR/EULAR antiphospholipid syndrome classification criteria, Ann Rheum Dis source

      The criteria figure (Discussion) states moderate positivity as 40–79 units and high positivity as >80 units for aCL and anti-β2GPI. However, the final definitions (Phase III-C) specify high positivity as ≥80 ELISA units, which includes exactly 80; the cited paper is inconsistent on that boundary. The thresholds also apply to standardized ELISA results, a qualification absent from the claim. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The 2023 ACR/EULAR criteria give isolated IgM positivity a low weight, insufficient for APS classification.

    “a low weight was given to isolated IgM positivity, leading to an insufficient score for APS classification even when clinical criteria are met.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [1] Barbhaiya, 2023, ACR/EULAR antiphospholipid syndrome classification criteria, Ann Rheum Dis source

  • May combine two claims.

    Premisecitation

    Even in standardized ELISA and CLIA tests there are discrepancies in absolute values, which represent a drawback for APS scoring in the new criteria.

    “Miro-Mur et al. [4] observed that even in standardized ELISA and chemiluminescence immunoassay (CLIA) tests there are some discrepancies in the absolute values, which represent a relevant drawback for APS scoring in the new criteria”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] Miro-Mur, 2024, Correspondence on ‘2023 ACR/EULAR antiphospholipid syndrome classification criteria’, Ann Rheum Dis source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The major novelty in the new criteria is the scoring system for APS classification: classify if at least 3 points from clinical domains and at least 3 points from laboratory domains.

    “The major novelty in the new criteria is the scoring system for APS classification: we can classify a patient as having APS if there are at least 3 points from clinical domains and at least 3 points from laboratory domains [1].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [1] Barbhaiya, 2023, ACR/EULAR antiphospholipid syndrome classification criteria, Ann Rheum Dis source

      The Abstract states that patients with at least three points each from the clinical and laboratory domains are classified as having APS, and the Discussion describes separate point requirements as a refinement of earlier criteria. But the Abstract also specifies an entry criterion—a positive antiphospholipid antibody test within three years of an associated clinical criterion—so the two scores alone are not sufficient as the citing sentence implies. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The quality of life of PAPS patients has significantly improved as a result of an early diagnosis and effective treatment.

    “As we know that the quality of life of PAPS patients has significantly improved as a result of an early diagnosis and effective treatment [10]”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Ruffatti, 2023, Prevalence and adverse consequences of delayed diagnosis and misdiagnosis in thrombotic antiphospholipid syndrome. An observational cohort study and a review of the literature, Clin Rheumatol source

      The Results report no further thrombosis after correct diagnosis and appropriate treatment, and the Discussion says timely diagnosis and treatment can improve patients’ prognoses. The paper does not report a measured, statistically significant improvement in quality of life for patients with primary APS (PAPS). (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    After excluding three unclassified patients who had provoked thrombosis, the rate of thrombotic recurrence was 8.8% in classified and 18.8% in not classified patients.

    “after excluding the three unclassified patients who had a provoked thrombosis (i.e. after anti-thrombotic therapy discontinuation), the rate of thrombotic recurrence in classified and not classified patients was similar, being 8.8% and 18.8%, respectively.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    No difference in follow-up duration was observed between classified and unclassified patients.

    “and follow-up duration (13.2 ± 9.7 years vs 13.4 ± 8.6) was observed”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.

  • May combine two claims.

    Premisecitation

    Four of these patients (3.8%) had retinal thrombosis, which was associated with an isolated positive IgM aPL test (P = 0.005).

    “Moreover, four of these patients (3.8%) had retinal thrombosis, which was associated to an isolated positive IgM aPL test (P = 0.005) [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Del Ross, 2015, The clinical relevance of the IgM isotype of antiphospholipid antibodies in the vascular antiphospholipid syndrome, Thromb Res source

  • May combine two claims.

    Premisecitation

    IgM aCL and aβ2GPI are valid biomarkers for APS classification, especially when associated with each other and stable over time.

    “This study suggests IgM aCL and aβ2GPI are valid biomarkers for APS classification, especially when they are associated with each other and stable over time [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Del Ross, 2015, The clinical relevance of the IgM isotype of antiphospholipid antibodies in the vascular antiphospholipid syndrome, Thromb Res source

  • May combine two claims.

    Interpretationown data

    The new criteria potentially exclude high-risk patients, as demonstrated by the significant proportion of patients with thrombotic recurrences not fulfilling the new criteria in our cohort.

    “Conversely, the new criteria potentially exclude high-risk patients, as demonstrated by the significant proportion of patients with thrombotic recurrences not fulfilling the new criteria in our cohort.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The data used in the study were analysed retrospectively.

    “The data used in the study were analysed retrospectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The duration of follow-up for individual patients varies, which may affect the assessment of thrombotic relapse risk and reduce the comparability of results between patients with different monitoring times.

    “Finally, although the study covers a long observation period, the duration of follow-up for individual patients varies. This may affect the assessment of thrombotic relapse risk and reduce the comparability of results between patients with different monitoring times.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisereasoning

    This occurs at the cost of lower sensitivity.

    “Obviously, this occurs at the cost of lower sensitivity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    This exclusion could limit the applicability of research findings to the broader APS population and could lead to a lack of evidence of appropriate treatment for these patients.

    “This exclusion could limit the applicability of research findings to the broader APS population and could lead to a lack of evidence of appropriate treatment for these patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Different results were obtained with the same sample depending on the choice of ELISA method, challenging the defensibility of a fixed cut-off.

    “In fact, different results were obtained with the same sample depending on the choice of ELISA method, challenging the defensibility of a ‘fixed’ cut off.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Huisman, 2024, Antiphospholipid solid phase based assays: problems and proposed solutions for the 2023 ACR/EULAR classification criteria for antiphospholipid syndrome, J Thromb Haemost source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The 99th percentile may vary depending on the ELISA supplier and should be determined locally.

    “Huisman et al. [3] stated that it seems more convincing to consider the 99th percentile, which may vary depending on the ELISA supplier and which should be determined locally.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Huisman, 2024, Antiphospholipid solid phase based assays: problems and proposed solutions for the 2023 ACR/EULAR classification criteria for antiphospholipid syndrome, J Thromb Haemost source

  • May combine two claims.

    Study design and conductreasoning

    The analysis was limited to patients with thrombotic events, excluding those with pregnancy-related morbidity, which may reduce the generalizability of the results.

    “Moreover, we limited our analysis to patients with thrombotic events, excluding those with pregnancy-related morbidity. This may reduce the generalizability of our results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The new criteria are considered an improvement from the Sydney classification criteria for APS, as they had a high specificity.

    “The new criteria are considered as an improvement from the Sydney classification criteria for APS [5], as they had a high specificity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Miyakis, 2006, International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS), J Thromb Haemost source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Using the 99th percentile as the cut-off for a positive test would have been more appropriate.

    “Using as cut-off for positive test the 99th percentile would have been more appropriate.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    The 2023 ACR/EULAR criteria distinguish between aCL or aβ2GPI IgG vs IgM isotypes.

    “The 2023 American College of Rheumatology / European Alliance of Associations for Rheumatology (ACR/EULAR) antiphospholipid syndrome (APS) classification criteria distinguish between anticardiolipin (aCL) or anti-β2-glycoprotein I (aβ2GPI) IgG vs IgM isotypes”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    The new criteria may provide a more rigorous framework for selecting patients in research settings, potentially leading to more accurate assessments of treatment efficacy and safety in those who meet the APS classification.

    “The new criteria may provide a more rigorous framework for selecting patients in research settings, potentially leading to more accurate assessments of treatment efficacy and safety in those who meet the APS classification.”
    Quote in the paperNot a substantial claim
25 of 25

  • The paper relies on this without support.

    Patients fulfilling the Sydney classification criteria are a valid reference standard for identifying PAPS.

    “PAPS patients were needed to meet the Sydney classification criteria [5], and they were re-evaluated based on the 2023 ACR/EULAR APS classification criteria [1].”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • High-risk VTE prevalence and P value disagree with Table 2

    Minor

    The prose gives 9.4% and P = 0.004 for the unconfirmed group's high-risk VTE profile, whereas Table 2 gives 2 of 34 (5.9%) and P = 0.01.

  • Confirmed-group recurrence percentage uses the wrong denominator

    Minor

    Fourteen recurrences among 171 confirmed patients is 8.19%, not the reported 8.8%.

    Reported 8.8 · recomputed 8.187135

  • Arterial-event percentage does not match the unconfirmed group size

    Minor

    The reported 19 arterial events among 34 unconfirmed patients represent 55.88%, not 60%.

    Reported 60 · recomputed 55.882353

  • Female cohort total disagrees with group counts

    Minor

    The results state that the cohort included 145 females, but Table 2 lists 125 confirmed and 22 unconfirmed female patients, totaling 147.

  • Unconfirmed-group recurrence percentage does not match the post-exclusion count

    Minor

    After excluding three of the 34 unconfirmed patients, the denominator is 31. Six recurrences among 31 patients is 19.35%, not 18.8%.

    Reported 18.8 · recomputed 19.354839

5 of 5

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Authors
Zen, M., Tonello, M., Carta, F., Calligaro, A., Favaro, M., Del Ross, T., Hulej, G., Rahmé, Z., Ruffatti, A., & Doria, A.
Affiliations
  • University of Padua (IT)
  • Azienda Ospedale - Università Padova (IT)
  • Rheumatology Unit, Padua University Hospital , Padua,
Corresponding author
Zen, Margherita
ORCID
Venue
Rheumatology
Publisher
Oxford University Press (OUP)
Published
2024-12-17
Volume
64
Issue
7
Pages
4325-4330
ISSN
  • 1462-0324 (ISSN-L)
  • 1462-0332
DOI
10.1093/rheumatology/keae665
PMC
PMC12212896
OpenAlex
W4405464158
Semantic Scholar
6c2de6882e7d2bb1c8d36ebb491daffedcf373b1
Cited by
7
References
13
Citations by year
2026: 5 · 2025: 2
FWCI
1.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Lara D. Veeken (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc)
  • Padua Research Archive (University of Padova) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
Keywords
antiphospholipid syndrome, anticardiolipin antibodies, anti-beta2-glycoprotein I antibodies, antithrombotic therapy, diagnostic reclassification
MeSH terms
Adult, Aged, Female, Humans, Immunoglobulin G, Immunoglobulin M, Male, Middle Aged, Recurrence, Rheumatology, Thrombosis, Cohort Studies, Antiphospholipid Syndrome, Antibodies, Antiphospholipid, Antibodies, Anticardiolipin, beta 2-Glycoprotein I

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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