Colchicine reduces complications of cardiac surgery
MedWire News: Treatment with colchicine following cardiac surgery reduces the incidence of postoperative atrial fibrillation (POAF), results of a COPPS (COlchicine for the Prevention of the post-Pericardiotomy Syndrome) substudy show.
Patients treated with colchicine also had a shorter in-hospital stay and rehabilitation stay compared with those given placebo.
"Such findings may be particularly important for clinical practice because colchicine might represent a cheap and relatively safe option for the prevention of both the postpericardiotomy syndrome [PPS] and POAF, two common and troublesome complications of cardiac surgery," the authors commented.
The COPPS POAF substudy included 336 participants of the COPPS trial and aimed to evaluate the efficacy of colchicine in preventing POAF at 1 month.
On the third postoperative day, patients undergoing cardiac surgery and without contraindications to colchicine were randomly assigned to receive placebo (n=167) or colchicine (n=169; 1.0 mg twice daily on the third postoperative day followed by a maintenance dose of 0.5 mg twice daily).
"Colchicine has previously been shown to be safe and effective in the prevention of pericarditis," noted Massimo Imazio (Maria Vittoria Hospital, Torino, Italy), presenting the results at the 2011 American Heart Association Scientific Sessions in Orlando, Florida. He added that in the main COPPS trial, colchicine halved the incidence of PPS.
After 1 month of treatment, patients receiving colchicine had a significantly reduced incidence of POAF compared with those receiving placebo, at 12.0% versus 22.0% (p=0.021). This translated to a relative risk reduction of 45.5% and a number needed to treat of 11.
Colchicine patients also had a shorter in-hospital stay (9.4 vs 10.3 days [p=0.040]), rehabilitation stay (12.1 vs. 13.9 days [p=0.009]), and overall hospital stay (21.4 vs 24.2 days [p=0.030]) compared with those receiving placebo.
No severe side effects were documented. However, colchicine did show a trend toward an increased rate of gastrointestinal complications compared with placebo (16 vs 7, respectively [p=0.082]), notes the team in the journal Circulation.
Discussant Nancy Nussmeier, from SUNY Upstate Medical University in Syracuse, New York, said that this might "limit the usage of the drug." She also noted that colchicine treatment was started on postoperative day 3, and therefore the potential beneficial effect of the drug was limited to starting from this day.
Despite this, "colchicine is potentially a cheap, effective, and relatively safe option for decreasing the incidence of PPS and POAF," she concluded.
The study is published in the journal Circulation.
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By Nikki Withers