Venous thromboembolism risk increases within 30 days after gout flare
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Patients with gout demonstrate an increased risk for venous thromboembolism during the 30 days following a flare consultation or hospitalization, according to data published in Arthritis & Rheumatology.
“Large cohort studies have demonstrated an association between gout and [venous thromboembolism] compared with the general population,” Edoardo Cipolletta, MD, of the University of Nottingham, in the United Kingdom, and colleagues wrote. “However, to the best of our knowledge whether gout flares are temporally associated with VTE has not been evaluated.”
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To investigate a potential temporal association between gout flares and venous thromboembolism (VTE), Cipolletta and colleagues examined electronic primary care records from the Clinical Practice Research Datalink in the United Kingdom, linked to hospitalization and mortality registers. Using a self-controlled case series analysis, the researchers adjusted for season and estimated the temporal link between VTE and gout flares. To be included in the study, patients needed to be aged 18 years or older and have experienced incident gout flare at least 1 year removed from their current general practice provider.
The exposure variable of interest was a gout flare, defined for the purposes of this analysis as a gout-specific diagnostic code, prescriptions of anti-inflammatory drugs on the same date as a consultation for a gout flare, or a hospitalization with a primary diagnosis of gout. The exposure period was set at the 90 days following a primary care consultation or hospitalization for gout flare.
Patients were considered to have experienced VTE if they had a primary care diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE), and had a prescription for an anticoagulation drug, were hospitalized with DVT or PE as a primary diagnosis, had a “fatal episode” of VTE, or died within 30 days of a diagnosis of DVT or PE, the researchers wrote.
The analysis included 314 patients. According to the researchers, the incidence of VTE was significantly higher in the gout-exposure period than in the baseline period (aIRR = 1.83; 95% CI, 1.3-2.59). Additionally, the likelihood of VTE in the 30 days following a gout flare was higher than in the baseline period (aIRR = 2.31; 95% CI, 1.39-3.82). There was no observed increase in VTE from 31 to 60 days, or 61 to 90 days, following a gout flare.
“In this study using SCCS analysis, we reported a significant transient association between gout flares and VTE in the subsequent 90 days, with most of the excess risk in the first 30 days immediately after a gout flare consultation/hospitalization,” Cipolletta and colleagues wrote. “Patients with gout should be counselled about the increased risk of VTE and advised to remain well hydrated and active in the 30 days after the gout flare.”
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