We evaluated the clinical relevance of testing for aβ2GP1-Dm1 in thrombotic APS. 40% of patients with positive aβ2GP1 presented aβ2GP1-Dm1 antibodies. Anti-β2GP1-Dm1 was not associated with the site of thrombosis or recurrence. Positive aβ2GP1-Dm1 was more prevalent in SLE and triple aPL positivity patients. Anti-β2GP1-Dm1 detected patients at risk for systemic autoimmunity.