Abstract
BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic necessitated rapid advances in treatment, with Paxlovid emerging as an effective oral antiviral. Despite its efficacy in reducing hospitalizations and mortality among high-risk patients, the impact of Paxlovid on cardiovascular outcomes remains unclear, especially given the increased cardiovascular risks associated with COVID-19. METHODS: We conducted a retrospective cohort study using data from the Chang Gung Memorial Hospital System in Taiwan of patients admitted with COVID-19 from January 1, 2022 to December 31, 2022. Propensity score matching was used to create comparable cohorts of patients treated with Paxlovid and those not treated with Paxlovid. The primary outcomes were cardiovascular events and all-cause mortality within a 12-month follow-up period. RESULTS: The study analyzed 606 patients treated with Paxlovid and 1,809 matched patients who were not. Paxlovid significantly reduced all-cause mortality at 3 months (relative risk [RR] 0.75, p = 0.0216) and 6 months (RR 0.81, p = 0.0492), but this effect was not sustained at 12 months (p = 0.2069). Notably, venous thromboembolism rates were significantly higher in the Paxlovid group at 6 months (RR 4.78, p = 0.0057) and 12 months (RR 2.65, p = 0.0477). CONCLUSIONS: While Paxlovid treatment resulted in significant short-term survival improvements among COVID-19 patients, it was also associated with a higher incidence of venous thromboembolic complications. These findings highlight the need for careful patient selection and monitoring, particularly for those with preexisting cardiovascular conditions.