Colchicine for Prevention of Atrial Fibrillation after Cardiac Surgery in the Early Postoperative Period

Abstract

Background. Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. It has been proven to be associated with an increase in the incidence of early complications and mortality, an increase in the rate of hospital stay duration, and economic costs of their treatment. One of the pharmaceutical drugs recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) for preventing POAF is colchicine (class IIB). However, the results of research on the efficacy and safety of colchicine are ambiguous and, consequently, require further study. Objective. Evaluating the efficacy of short-term colchicine administration in the prevention of POAF in patients after open-heart surgery. Materials and methods. Double-blind, randomized, placebo-controlled clinical trial. The subjects were randomly assigned to two groups: treatment group (n = 50) with subjects receiving 1 mg of colchicine 24 h before the surgery, as well as on days 2, 3, 4, and 5 in the postoperative period; and the control group (n = 51), receiving placebo on the same schedule. The primary endpoint was the frequency of POAF in both groups within 7 days after surgery. Results. The study included 101 patients (82 men, 19 women). Baseline clinical, laboratory, instrumental, and intraoperative data did not differ statistically significantly between the groups. POAF was detected in 9 patients (18%) of the treatment group and 15 subjects (29.4%) of the control group, which had no statistical significance (odds ratio, OR 0.527; 95% Cl 0.206–1.349; p = 0.178). No statistically significant differences were revealed for most secondary endpoints, as well as between the groups for all laboratory parameters. There were statistically significant differences between the groups solely in the frequency of diarrhea: 16 (32%) patients in the treatment group and 6 (11.8%) subjects in the control group (OR 3.529; 95% Cl 1.249–9.972; p = 0.010). Conclusions. We did not detect any statistical differences between the groups in terms of primary endpoints, which could be due to the insufficient volume of the sample of the study. However, we detected some trends of statistical differences among the groups in terms of some parameters. Clinical Trials Registration. ClinicalTrials. Unique identifier: NCT04224545.

Colchicine for Prevention of Post-Cardiac Surgery and Post-Pulmonary Vein Isolation Atrial Fibrillation: A Meta-Analysis

“…Subsequently, another RCT study published by Sarzaeem et al [7] in 2014 fur-ther supports the preventive effect of colchicine on POAF. However, although all the other six studies, including the COPPS2 study, concluded that the incidence of atrial fibrillation in the colchicine group was low, they failed to produce a statistical difference from the control group [6][7][8][9][16][17][18][19]. Through our meta-analysis of all studies, we concluded that colchicine can effectively prevent post-operative atrial fibrillation.…”

“…Then after discussion, incomplete data and non-cardiac surgery were excluded, and 12 RCTs were included (Fig. 1) [6][7][8][9][12][13][14][15][16][17][18][19]. We extracted study characteristics such as study design, baseline characteristics, sample size, type of procedures, intervention, primary and secondary outcomes, follow-up duration and side events.…”

“…All study characteristics and baseline data can be viewed in Table 1 (Ref. [6][7][8][9][12][13][14][15][16][17][18][19]) and Table 2, respectively. Eight RCTs were prospective, double-blinded, randomized, placebo-controlled trials.…”

Colchicine in Cardiac Surgery: The COCS Randomized Clinical Trial

“…Therefore, to assess the variance in POAF rates, we performed a preliminary analysis of our data after randomization of 100 patients. According to the inclusion/exclusion criteria and selected surgical interventions (CABG and/or AVR), at the preliminary stage of the analysis, it was shown that incidence rates of POAF were 18% in the experimental group vs. 29.4% in the control group [ 33 ].…”

Immune remodeling and atrial fibrillation

“…Deftereos et al also showed that colchicine administration, at a dose of 0.5 mg twice daily, for 3 months after pulmonary vein isolation in patients with paroxysmal AF, resulted in a significantly lower rate of AF recurrence over a median of 15 months of follow-up (Deftereos et al, 2014). However, a recent randomized controlled trial (1 mg of colchicine 24 h before the surgery, as well as on days 2, 3, 4, and 5 in the postoperative period) did not detect any statistically significant differences between the control and colchicine groups within 7 days after surgery (Shvartz et al, 2022). Two other studies also found similar results (Bessissow et al, 2018;Tabbalat et al, 2020).…”