Association between Active Cancer and Risk of Thrombotic and Cardiovascular Outcomes in Outpatients with COVID-19: A CORONA-VTE Network Analysis

Bridget McGonagle; Christie Greason; Darsiya Krishnathasan; Giovanni Scimeca; Antoine Bejjani; Candrika D. Khairani; Nada Hamade; Alyssa Sato; Hannah Leyva; Umberto Campia; Julia Davies; Nicole Porio; Ali A. Assi; Andre Armero; Anthony Tristani; Marcos D. Ortiz-Rios; Victor Nauffal; Zaid Almarzooq; Eric Wei; Valeria Zuluaga-Sánchez; Mehrdad Zarghami; Aditya Achanta; Sirus J. Jesudasen; Bruce C. Tiu; Geno J. Merli; Orly Leiva; John Fanikos; Aditya Sharma; Samantha Rizzo; Mariana B. Pfeferman; Ruth B. Morrison; Alec Vishnevsky; Judith Hsia; Mark R. Nehler; James Welker; Marc P. Bonaca; Brett J. Carroll; Samuel Z. Goldhaber; Zhou Lan; Behnood Bikdeli; Gregory Piazza

doi:10.1055/a-2713-2715

TH Open, Inhaltsverzeichnis

CC BY 4.0 · TH Open 2025; 09: a27132715
DOI: 10.1055/a-2713-2715

Original Article

Association between Active Cancer and Risk of Thrombotic and Cardiovascular Outcomes in Outpatients with COVID-19: A CORONA-VTE Network Analysis

Authors

Bridget McGonagle

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Christie Greason

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Darsiya Krishnathasan

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Giovanni Scimeca

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

³Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts, United States
Antoine Bejjani

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Candrika D. Khairani

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Nada Hamade

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Alyssa Sato

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Hannah Leyva

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Umberto Campia

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Julia Davies

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Nicole Porio

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Ali A. Assi

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

⁴Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Andre Armero

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Anthony Tristani

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Marcos D. Ortiz-Rios

⁴Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Victor Nauffal

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Zaid Almarzooq

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Eric Wei

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Valeria Zuluaga-Sánchez

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Mehrdad Zarghami

⁴Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Aditya Achanta

⁵Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
Sirus J. Jesudasen

⁶Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
Bruce C. Tiu

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Geno J. Merli

⁷Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
Orly Leiva

⁴Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
John Fanikos

⁸Department of Pharmacy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
Aditya Sharma

⁹Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, Virginia, United States
Samantha Rizzo

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Mariana B. Pfeferman

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Ruth B. Morrison

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Alec Vishnevsky

⁶Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
Judith Hsia

¹⁰CPC Clinical Research, Aurora, Colorado, United States

¹¹Department of Medicine, University of Colorado, Aurora, Colorado, United States
Mark R. Nehler

¹⁰CPC Clinical Research, Aurora, Colorado, United States
James Welker

¹²Department of Medicine, Anne Arundel Research Institute, Annapolis, Maryland, United States
Marc P. Bonaca

¹⁰CPC Clinical Research, Aurora, Colorado, United States

¹¹Department of Medicine, University of Colorado, Aurora, Colorado, United States
Brett J. Carroll

¹³Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
Samuel Z. Goldhaber

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Zhou Lan

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

¹⁴Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Behnood Bikdeli

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

¹⁵Yale New Haven Hospital/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
Gregory Piazza

¹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

²Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

Abstract

Background

Coronavirus disease 2019 (COVID-19) and active cancer are each independently associated with excess risk of thrombotic and cardiovascular events. However, data are limited regarding the risk of these events in outpatients with active cancer and concomitant COVID-19.

Objectives

This study aimed to retrospectively examine the association between active cancer and thrombotic and cardiovascular outcomes among non-hospitalized patients with COVID-19.

Methods

Data from the outpatient cohort with confirmed COVID-19 from the 10,420-patient multicenter U.S. CORONA-VTE Network registry were used. Active cancer was defined as having a malignancy diagnosis (excluding non-melanoma skin cancer) or receiving cancer-related treatment within the past year. Outcomes were independently adjudicated and included a composite of venous and arterial thromboembolism, and a composite of major adverse cardiovascular events, including thromboembolism, heart failure, myocarditis, new atrial fibrillation, and cardiovascular death within 90 days of COVID-19 diagnosis.

Results

The registry included 6,576 outpatients, of whom 166 (2.5%) had active cancer (mean age 61 ± 16, 53% female). For outpatients with and without active cancer, the 90-day cumulative incidences of thromboembolism after developing COVID-19 were 4.2% and 1.2%, respectively (hazard ratio [HR]: 3.65; 95% confidence interval [CI]: 1.73–7.69, p < 0.001). Corresponding 90-day cumulative incidences of cardiovascular events were 5.4% and 1.9% (HR: 2.97; 95% CI: 1.46–6.05, p = 0.003). In adjusted analyses, non-hospitalized patients displayed an increased risk of thrombotic outcomes (HR: 2.48, 95% CI: 1.13–5.45, p = 0.024) but not cardiovascular outcomes (HR: 1.76, 95% CI: 0.85–3.62, p = 0.13).

Conclusion

Outpatients with COVID-19 and active cancer demonstrated an increased hazard of thrombotic events compared with outpatients without cancer.

Keywords

cancer - cardiovascular events - COVID-19 - deep vein thrombosis - pulmonary embolism

Bibliographical Record
Bridget McGonagle, Christie Greason, Darsiya Krishnathasan, Giovanni Scimeca, Antoine Bejjani, Candrika D. Khairani, Nada Hamade, Alyssa Sato, Hannah Leyva, Umberto Campia, Julia Davies, Nicole Porio, Ali A. Assi, Andre Armero, Anthony Tristani, Marcos D. Ortiz-Rios, Victor Nauffal, Zaid Almarzooq, Eric Wei, Valeria Zuluaga-Sánchez, Mehrdad Zarghami, Aditya Achanta, Sirus J. Jesudasen, Bruce C. Tiu, Geno J. Merli, Orly Leiva, John Fanikos, Aditya Sharma, Samantha Rizzo, Mariana B. Pfeferman, Ruth B. Morrison, Alec Vishnevsky, Judith Hsia, Mark R. Nehler, James Welker, Marc P. Bonaca, Brett J. Carroll, Samuel Z. Goldhaber, Zhou Lan, Behnood Bikdeli, Gregory Piazza. Association between Active Cancer and Risk of Thrombotic and Cardiovascular Outcomes in Outpatients with COVID-19: A CORONA-VTE Network Analysis. TH Open 2025; 09: a27132715.
DOI: 10.1055/a-2713-2715

Volltext

Referenzen

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