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months (two-sided level 5%), only the treatment with rEPO was found to be an independent VTE risk factor (OR 3.7, 95% CI 5 1.34 2 10.20; P 5 0.01; Table I).Thus, while usual VTE risk factors were recorded in this observational study, none of them except rEPO were identified as predictor of VTE in newly diagnosed MM patients treated with IMIDs. Therefore, it seems that higher-risk IMID treated patients are only those receiving rEPO and all these patients should be treated with prophylactic LMWH. Neither the retrospective study [2] nor this prospective register, allow to conclude about other VTE risk factors. This lack of data on additional risk factors makes the use of guidelines difficult. The use of hyperviscosity, high-dose dexamethasone, and the following factors as stated above are potential areas of future study. In addition, as it was already reported [2,6,7], this analysis could not show that the choice of VTE prophylaxis had an impact on the occurrence of VTE, but these studies were not designed or powered to assess the efficiency of thromboprophylaxis.Considering the risks and costs associated with the different type of antithrombotic treatments and the fact that different impact of different risk factors is not taken into account, society guidelines recommending thromboprophylaxis in patients with MM should be revisited. Moreover, as high level recommendations cannot exist, it is important to develop recommendations in this field on the basis of experience. Data on rEPO have to be added to all guidelines and we need prospective studies to propose a reliable VTE risk stratification in such patients.

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Background It has been shown that gout is associated with left atrium remodeling and a pro‐inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF. Methods This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD‐10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre‐existing AF and gout. Results In 2016, we identified 3 844 057 patients admitted to the hospitals in NIS with history of AF, of which 240 875 had history of gout. Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97‐2.19], P < .001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01‐1.11], P = .041). However, presence of gout in patients with AF was not associated with all‐cause in‐hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility. Conclusion Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.

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