Cardiovascular Outcomes in COVID-19 Patients Treated with Paxlovid: A Multicenter Retrospective Study

Abstract: Acta Cardiol Sin 2026;42:87-98 Original Article doi: 10.6515/ACS.202601_42(1).20250726A General Cardiology Cardiovascular Outcomes in COVID-19 Patients Treated with Paxlovid: A Multicenter Retrospective Study Wei-Lun Chen,1 Victor Chien-Chia Wu,1,2 Chun-Li Wang,1,2 Yu-Ching Wang,3 Yu-Tung Huang,3 Chien-Hao Huang,2,4 Chih-Hsiang Chang,2,5 Shao-Wei Chen,2,3,6 Shang-Hung Chang,1,2,3,7 Cheng-Hsun Chiu8,9 and Pao-Hsien Chu1,2,10 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. Key Words: Cardiovascular events · COVID-19 · Mortality · Outcome · Paxlovid Abbreviations CGMF CGMH CGRD CI COVID-19 DDI ICD-9-CM Received: June 3, 2025 Accepted: July 26, 2025 1 Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center; 2College of Medicine, Chang Gung University; 3Center for Big Data Analytics and Statistics; 4Division of Hepatology, Department of Gastroenterology and Hepatology; 5Department of Nephrology, Kidney Research Center; 6Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center; 7Graduate Institute of Nursing, Chang Gung University of Science and Technology; 8 Molecular Infectious Disease Research Center; 9Division of Pediatric Infectious Diseases, Department of Pediatrics; 10Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Corresponding author: Dr. Pao-Hsien Chu, Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan. Tel: 886-3-328-1200 ext. 8115; Fax: 886-3-328-1451; E-mail: taipei.chu@gmail.com ICD-10-CM IRB RR SARS-CoV-2 VTE 87 Chang Gung Medical Foundation Chang Gung Memorial Hospital Chang Gung Research Database Confidence interval Coronavirus disease 2019 Drug-drug interaction International Classification of Diseases, Ninth Revision, Clinical..