The EULAR recommendations for the management of antiphospholipid syndrome (APS) in adults provide evidence-based guidance for the prevention and treatment of thrombotic and obstetric complications. The key principles include identifying high-risk aPL profiles, which are associated with increased risk of thrombosis and pregnancy complications. High-risk aPL profiles include the presence of lupus anticoagulant, double or triple aPL positivity, or persistently high aPL titres. Patients with high-risk aPL profiles are advised to receive long-term anticoagulation, such as vitamin K antagonists (VKA) with an INR target of 2–3 for venous thrombosis and 2–4 for arterial thrombosis. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with SLE without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS. For patients with recurrent thrombosis despite adequate treatment, LDA, increased INR target, or switch to low molecular weight heparin may be considered. In women with a history of obstetric APS, combination treatment with LDA and prophylactic heparin during pregnancy is recommended. For patients with recurrent pregnancy complications, increasing heparin dose, adding hydroxychloroquine, or low-dose prednisolone may be considered. Rivaroxaban is not recommended in patients with triple aPL positivity due to the high risk of recurrent events. For catastrophic APS, combination therapy with glucocorticoids, heparin, and plasma exchange or IVIG is recommended. The recommendations aim to improve patient outcomes by guiding treatment based on risk stratification and individual patient characteristics. The evidence is limited, and further research is needed to better define risk factors and treatment options.The EULAR recommendations for the management of antiphospholipid syndrome (APS) in adults provide evidence-based guidance for the prevention and treatment of thrombotic and obstetric complications. The key principles include identifying high-risk aPL profiles, which are associated with increased risk of thrombosis and pregnancy complications. High-risk aPL profiles include the presence of lupus anticoagulant, double or triple aPL positivity, or persistently high aPL titres. Patients with high-risk aPL profiles are advised to receive long-term anticoagulation, such as vitamin K antagonists (VKA) with an INR target of 2–3 for venous thrombosis and 2–4 for arterial thrombosis. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with SLE without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS. For patients with recurrent thrombosis despite adequate treatment, LDA, increased INR target, or switch to low molecular weight heparin may be considered. In women with a history of obstetric APS, combination treatment with LDA and prophylactic heparin during pregnancy is recommended. For patients with recurrent pregnancy complications, increasing heparin dose, adding hydroxychloroquine, or low-dose prednisolone may be considered. Rivaroxaban is not recommended in patients with triple aPL positivity due to the high risk of recurrent events. For catastrophic APS, combination therapy with glucocorticoids, heparin, and plasma exchange or IVIG is recommended. The recommendations aim to improve patient outcomes by guiding treatment based on risk stratification and individual patient characteristics. The evidence is limited, and further research is needed to better define risk factors and treatment options.