Major cardiovascular events after COVID-19, event rates post-vaccination, antiviral or anti-inflammatory therapy, and temporal trends: Rationale and methodology of the CORONA-VTE-Network study

Behnood Bikdeli; Candrika D Khairani; Darsiya Krishnathasan; Antoine Bejjani; Andre Armero; Anthony Tristani; Julia Davies; Nicole Porio; Ali A Assi; Victor Nauffal; Umberto Campia; Zaid Almarzooq; Eric Wei; Aditya Achanta; Sirus J Jesudasen; Bruce C Tiu; Geno J Merli; Orly Leiva; John Fanikos; Aditya Sharma; Alec Vishnevsky; Judith Hsia; Mark R Nehler; James Welker; Marc P Bonaca; Brett J Carroll; Zhou Lan; Samuel Z Goldhaber; Gregory Piazza; CORONA-VTE-Network Investigators

doi:10.1016/j.thromres.2023.05.019

Major cardiovascular events after COVID-19, event rates post-vaccination, antiviral or anti-inflammatory therapy, and temporal trends: Rationale and methodology of the CORONA-VTE-Network study

Thromb Res. 2023 Aug:228:94-104. doi: 10.1016/j.thromres.2023.05.019. Epub 2023 May 29.

Authors

Behnood Bikdeli¹, Candrika D Khairani², Darsiya Krishnathasan², Antoine Bejjani², Andre Armero², Anthony Tristani², Julia Davies², Nicole Porio², Ali A Assi³, Victor Nauffal⁴, Umberto Campia², Zaid Almarzooq⁴, Eric Wei⁴, Aditya Achanta⁵, Sirus J Jesudasen⁶, Bruce C Tiu⁷, Geno J Merli⁸, Orly Leiva⁹, John Fanikos¹⁰, Aditya Sharma¹¹, Alec Vishnevsky⁸, Judith Hsia¹², Mark R Nehler¹³, James Welker¹⁴, Marc P Bonaca¹², Brett J Carroll¹⁵, Zhou Lan¹⁶, Samuel Z Goldhaber², Gregory Piazza¹⁷; CORONA-VTE-Network Investigators

Affiliations

¹ Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Cardiovascular Research Foundation (CRF), New York, NY, USA.
² Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁶ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁷ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
⁸ Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁹ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
¹⁰ Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹¹ Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, VA, USA.
¹² CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA.
¹³ CPC Clinical Research, Aurora, CO, USA.
¹⁴ Anne Arundel Research Institute, Annapolis, MD, USA.
¹⁵ Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹⁶ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁷ Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: gpiazza@bwh.harvard.edu.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is associated with excess risk of cardiovascular and thrombotic events in the early post-infection period and during convalescence. Despite the progress in our understanding of cardiovascular complications, uncertainty persists with respect to more recent event rates, temporal trends, association between vaccination status and outcomes, and findings within vulnerable subgroups such as older adults (aged 65 years or older), or those undergoing hemodialysis. Sex-informed findings, including results among pregnant and breastfeeding women, as well as adjusted comparisons between male and female adults are similarly understudied.

Methods: Adult patients, aged ≥18 years, with polymerase chain reaction-confirmed COVID-19 who received inpatient or outpatient care at the participating centers of the registry are eligible for inclusion. A total of 10,000 patients have been included in this multicenter study, with Brigham and Women's Hospital (Boston, MA) serving as the coordinating center. Other sites include Beth Israel Deaconess Medical Center, Anne Arundel Medical Center, University of Virginia Medical Center, University of Colorado Health System, and Thomas Jefferson University Health System. Data elements will be ascertained manually for accuracy. The two main outcomes are 1) a composite of venous or arterial thrombotic events, and 2) a composite of major cardiovascular events, defined as venous or arterial thrombosis, myocarditis or heart failure with inpatient treatment, new atrial fibrillation/flutter, or cardiovascular death. Clinical outcomes are adjudicated by independent physicians. Vaccination status and time of inclusion in the study will be ascertained for subgroup-specific analyses. Outcomes are pre-specified to be reported separately for hospitalized patients versus those who were initially receiving outpatient care. Outcomes will be reported at 30-day and 90-day follow-up. Data cleaning at the sites and the data coordinating center and outcomes adjudication process are in-progress.

Conclusions: The CORONA-VTE-Network study will share contemporary information related to rates of cardiovascular and thrombotic events in patients with COVID-19 overall, as well as within key subgroups, including by time of inclusion, vaccination status, patients undergoing hemodialysis, the elderly, and sex-informed analyses such as comparison of women and men, or among pregnant and breastfeeding women.

Keywords: COVID-19; Cardiovascular events; Thrombosis; Trends; Venous thromboembolism.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Aged
Antiviral Agents / therapeutic use
COVID-19*
Female
Humans
Male
SARS-CoV-2
Thrombosis* / drug therapy
Vaccination / adverse effects
Venous Thromboembolism* / drug therapy

Substances

Antiviral Agents