Introduction: Studies in Western countries show that VTE recurrent rates are lower in the presence of a transient provoking factor, older age, female sex and/or hormonal use, while thrombophilia (factor V Leiden or prothrombin mutation) has no predictive role. This study aimed to determine the incidence and risk factors of recurrent VTE in Asian patients. Method: This is a retrospective cohort study in adult VTE patients who were diagnosed during 2004-2014, had no active cancer and followed-up for at least 1 year. Results: There were 198 patients. The mean age was 58.2 ± 17.6 years and 68.2% were female. The diagnoses were deep vein thrombosis (56%), pulmonary embolism (32%) or both (12%). They were provoked by major surgery in 21.7%. Thrombophilia (antiphospholipid syndrome or protein C or protein S deficiency) was found in 11.6%. The recurrent rate during the median follow-up time of 52 months was 2.2 (95% confidence interval [CI] 1.46-3.31) per 100 patient-years. Presence of thrombophilia was independently associated with recurrences with the adjusted hazard ratio (aHR) of 3.52 (95% CI 1.32-9.42, p = 0.01). There were 144 patients who discontinued anticoagulants. During the median time of 55 months after stopping anticoagulants, the recurrent rate was 4.3 per 100 patient-years. Thrombophilia was associated with recurrences with aHR of 4.00 (95% CI 1.42-11.31, p = 0.01), while male sex, younger age, provoking conditions and hormone use showed no significant association. Conclusion: VTE recurrent rate in Asians is comparable to Caucasians, but thrombophilia is the strongest risk factor.
ObjectiveThe study aimed to describe the prevalence and outcomes of gout flare in patients with comorbid gout hospitalized for COVID-19. Factors associated with gout flare, and hospital length of stay were explored.MethodsThis retrospective cohort study included adults with comorbid gout who were hospitalized for PCR-confirmed COVID-19 between March 2020 and December 2021 in three hospitals in Thailand. Prevalence, characteristics, and outcomes of gout flare were described. Factors associated with gout flare were explored using LASSO selection and multivariate logistic regression. Association between gout flare and hospital length of stay was explored using multivariate linear regression.ResultsAmong 8697 patients hospitalized for COVID-19, 146 patients with comorbid gout were identified and gout flare occurred in 26 (18%). Compared to those without flare, patients with gout flare had higher baseline serum urate and lower prevalence of use of urate-lowering therapy (ULT) and gout flare prophylaxis medications. One-third of gout flare episodes were treated with two or more anti-inflammatory medications. Logistic regression identified GOUT-36 rule ≥2, a predictive index for inpatient gout flare, as the only factor associated with gout flare (OR 5.46, 95%CI 1.18 to 25.37). Gout flare was found to be independently associated with hospital length of stay and added three days to hospital course.ConclusionGout flare occurred in 18% of patients with comorbid gout hospitalized for COVID-19 and added up to three days to hospital length of stay. Patients with suboptimal ULT appeared to be at high risk for gout flare during COVID-19 hospitalization.
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