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The aim of this study was to investigate the correlation between the different clinical and laboratory manifestations of antiphospholipid syndrome (APS) and to determine the presence of primary or secondary antiphospholipid antibodies (aPL) in patients affected by those different types of APS. In this cohort prospective study, patients were enrolled from May 2008 to December 2010, and the severity of the disease was assessed at enrolment and after 1 year. The diagnosis of APS was made using the criteria of Hughes et al. (1). All patients underwent a complete clinical examination and, for the cases, a detailed report including laboratory data, clinical history, current therapies and possible comorbidities was also issued. At enrolment, after 1 year and during follow-up, an assessment of thrombotic and obstetric complications was performed, using the criteria of Miyakis and Hughes (2), and final outcomes were reported. The patients were classified into two groups according to the final diagnosis. The following clinical characteristics were recorded: thrombotic manifestations (venous thrombosis, arterial thrombosis, venous thrombosis+arterial thrombosis), obstetric complications, arterial and/or venous thrombosis, obstetric complications+arterial and/or venous thrombosis, nephropathy and/or other non-thrombotic complications. The observed clinical and laboratory manifestations in the second group of APS and aPL-positive and aPL-negative patients were compared. A total of 289 patients were consecutively enrolled; 24 (8.2%) had primary APS, while 37 (12.7%) had secondary APS. At enrolment, 103 (35.8%) patients had aPL and were classified in the second group, while 36 (12.5%) were aPL-negative. The most common clinical manifestations were thrombotic events and obstetric complications. Other clinical manifestations were observed only