Aspirin-Containing Antiplatelet Therapy and In-Hospital Gout Flares in Acute Ischemic Stroke Patients with Gout and Hyperuricemia: A Retrospective New-User Cohort Study
- 1Tianjin Huanhu Hospital
Abstract
BackgroundAntiplatelet selection is challenging in patients with acute ischemic stroke (AIS), gout, and hyperuricemia. We compared the risk of in-hospital gout flares between aspirin-containing regimens and clopidogrel monotherapy, and examined subsequent aspirin discontinuation during dual antiplatelet therapy (DAPT).
MethodsA retrospective new-user cohort study was conducted based on electronic medical records (2019-2025). Patients were categorized into aspirin-containing therapy (aspirin monotherapy or DAPT with aspirin plus clopidogrel) and clopidogrel monotherapy groups. The primary analysis used IPTW-adjusted logistic regression. Interaction tests assessed effect modification and a Sankey diagram visualized DAPT treatment transition.
ResultsAmong 105,890 screened patients, 457 were enrolled (234 aspirin-containing therapy, 223 clopidogrel monotherapy). In-hospital gout flares occurred in 187 (40.9%). Aspirin-containing regimens were associated with a higher flare risk (OR = 1.57, 95% CI 1.07 - 2.31, P = 0.022). Results were consistent in sensitivity analyses. Higher SUA (OR 1.20 per 1-mg/dL increase, 95% CI 1.03-1.40; P = 0.023) and baseline mRS [≥]3 (OR 2.13, 95% CI 1.42-3.20; P < 0.001) were independently associated with in-hospital gout flares. No significant interactions were observed between antiplatelet regimens and SUA, mRS or urate-lowering therapy (ULT). Among DAPT recipients, aspirin discontinuation in patients with gout flares was 65.2%, 66.7%, and 56.0% in 2019-2021, 2022-2023, and 2024-2025, respectively, versus 47.8%, 28.6%, and 11.9% in those without flares.
ConclusionsIn AIS patients with gout and hyperuricemia, initiating aspirin-containing regimens was associated with a higher risk of in-hospital gout flares compared with clopidogrel monotherapy. Gout flares during DAPT were accompanied by frequent aspirin discontinuation, which may limit completion of guideline-recommended DAPT. Prospective studies are needed.
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BibTeX
@misc{ma2026aspirincontaining,
title = {{Aspirin-Containing Antiplatelet Therapy and In-Hospital Gout Flares in Acute Ischemic Stroke Patients with Gout and Hyperuricemia: A Retrospective New-User Cohort Study}},
author = {A. Ma and X. Xu and Y. Zhang},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.23.26366257},
url = {https://www.medrxiv.org/content/10.64898/2026.10.23.26366257v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Aspirin-Containing Antiplatelet Therapy and In-Hospital Gout Flares in Acute Ischemic Stroke Patients with Gout and Hyperuricemia: A Retrospective New-User Cohort Study
AU - A. Ma
AU - X. Xu
AU - Y. Zhang
PY - 2026
DA - 2026/10/23
PB - medRxiv
DO - 10.64898/2026.10.23.26366257
UR - https://www.medrxiv.org/content/10.64898/2026.10.23.26366257v1
AB - BackgroundAntiplatelet selection is challenging in patients with acute ischemic stroke (AIS), gout, and hyperuricemia. We compared the risk of in-hospital gout flares between aspirin-containing regimens and clopidogrel monotherapy, and examined subsequent aspirin discontinuation during dual antiplatelet therapy (DAPT). MethodsA retrospective new-user cohort study was conducted based on electronic medical records (2019-2025). Patients were categorized into aspirin-containing therapy (aspirin monotherapy or DAPT with aspirin plus clopidogrel) and clopidogrel monotherapy groups. The primary analysis used IPTW-adjusted logistic regression. Interaction tests assessed effect modification and a Sankey diagram visualized DAPT treatment transition. ResultsAmong 105,890 screened patients, 457 were enrolled (234 aspirin-containing therapy, 223 clopidogrel monotherapy). In-hospital gout flares occurred in 187 (40.9%). Aspirin-containing regimens were associated with a higher flare risk (OR = 1.57, 95% CI 1.07 - 2.31, P = 0.022). Results were consistent in sensitivity analyses. Higher SUA (OR 1.20 per 1-mg/dL increase, 95% CI 1.03-1.40; P = 0.023) and baseline mRS [≥]3 (OR 2.13, 95% CI 1.42-3.20; P < 0.001) were independently associated with in-hospital gout flares. No significant interactions were observed between antiplatelet regimens and SUA, mRS or urate-lowering therapy (ULT). Among DAPT recipients, aspirin discontinuation in patients with gout flares was 65.2%, 66.7%, and 56.0% in 2019-2021, 2022-2023, and 2024-2025, respectively, versus 47.8%, 28.6%, and 11.9% in those without flares. ConclusionsIn AIS patients with gout and hyperuricemia, initiating aspirin-containing regimens was associated with a higher risk of in-hospital gout flares compared with clopidogrel monotherapy. Gout flares during DAPT were accompanied by frequent aspirin discontinuation, which may limit completion of guideline-recommended DAPT. Prospective studies are needed.
ER -