Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

Abstract

BackgroundThe high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality.ObjectiveTo assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors.MethodsBetween May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery.ResultsThe primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007).ConclusionThe use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr.

Colchicine for primary prevention of atrial fibrillation after open-heart surgery: Systematic review and meta-analysis

“…[12,23,24] One study also reported the incidence of post-operative infection; although the exact nature of the infections was unspecified. [25]…”

“…Six RCTs were reviewed for eligibility and five included. [12,[23][24][25]30] One paper written in Farsi (with an English abstract) was translated using online tools and checked by a cardiologist who was a native Farsi-speaker. Table 1 summarizes study and intervention characteristics of the RCTs.…”

“…Follow-up ranged from one week to three months. Two RCTs measured POAF only after CABG [25,39], whereas the other three (COPPS, COPPS-2 and END-AF) enrolled patients after valve surgery or combined valve and CABG surgery [12,23,24]. Atrial fibrillation was diagnosed objectively either by continuous ECG monitoring or by 12-lead ECG-recording.…”

“…[23,24] Three studies were double blinded, while two used open-label design. [12,25] No study showed evidence of bias from incomplete data. Three studies specified intention-to-treat analysis.…”

Efeitos do uso da colchicina em melhora de alterações miocárdicas correlacionadas com prevenção e complicação do infarto agudo do miocárdio: revisão sistemática / Effects of the colchicine to improve myocardial changes correlated with prevention and complication of acute myocardial infarction: systematic review

“…Dentre os efeitos farmacológicos que a colchicina desempenha, resultantes da atuação sobre a divisão celular, temos principalmente o efeito anti-inflamatório 3 . Sua diferença para outros medicamentos da mesma classe é que sua pluralidade de ações simultâneas converge em uma implicação mais vigorosa da inativação inflamatória (4)(5) .…”