Colchicine provides no sweeping benefit after cardiac surgery

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Patients undergoing cardiac surgery had mixed results when using colchicine to reduce the incidence of postpericardiotomy syndrome, postoperative atrial fibrillation (AF) or postoperative pericardial or plural effusion, according to a study published online Aug. 30 in JAMA.

According to prior studies, more than one-third of patients who underwent cardiac surgery have experienced postoperative AF, pericardial or plural effusions or postpericardiotomy syndrome within three months of surgery. Hoping to reduce these numbers, Massimo Imazio, MD, of the Maria Vittoria Hospital and University of Torino, and colleagues explored the use of colchicine, an oral anti-inflammatory. To do so, the research team compared colchicine use to a placebo in patients undergoing cardiac surgery. The drug was taken before and up to one month following surgery and patients were followed up for three months postsurgery.

They found that the best results occurred in preventing postpericardiotomy syndrome, however both a high dropout rate due to adverse events and a lack of significant improvement over placebo in combating postoperative plural or pericardial effusion or AF reduced the overall benefit.

When taken to prevent postpericardiotomy syndrome, colchicine saw moderate success over placebo (19.4 percent vs 29.4 percent). However, 33.9 percent of patients taking colchicine and 41.7 percent of patients taking placebo experienced postoperative AF. More than half of patients in both groups experienced postoperative pericardial or plural effusions.

Due to minor adverse events and gastrointestinal intolerance of colchicine, 17.8 percent of placebo patients and 21.7 percent of colchicine patients dropped out.

This study is a follow-up on the Colchicine for Prevention of the Postpericardiotomy Syndrome and Postoperative Atrial Fibrillation (COPPS) trial, where colchicine reduced incidence of these common complications after cardiac surgery and shortened in-hospital and rehabilitation stays.

Imazio et al recommended that due to the high rate of adverse events, colchicine should be used only after careful consideration of patient’s risks.