Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial

Tabbalat, Ramzi; Alhaddad, Imad A.; Hammoudeh, Ayman; Khader, Yousef; Khalaf, Hassan Abu; Obaidat, Mohammad M.; Barakat, Jude

doi:10.1177/0300060520939832

Cited by 21 publications

(34 citation statements)

References 22 publications

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“…A statistically significant difference was discovered only for the frequency of diarrhea occurrence in the early postoperative period. This indicator was higher in the treatment group (16 (32%) patients) than in the control group (6 (11.8%) patients), which was consistent with available published data on the negative effect of colchicine on the digestive tract [ 6 , 7 , 10 , 19 ].…”

Section: Discussionsupporting

confidence: 90%

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

Shvartz

Kryukov

et al. 2022

JCM

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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.

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Section: Discussionsupporting

confidence: 90%

“…Therefore, the outcomes of research on the efficacy of colchicine are ambiguous and require further investigation [ 18 , 19 , 20 ]. In this regard, the objective of our study was to evaluate the efficacy of short-term colchicine administration in terms of preventing POAF in patients after open-heart surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Shvartz

Kryukov

et al. 2022

JCM

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“…independently reviewed the 149 identified articles. Finally, we included 9 RCTs that evaluated the efficacy of colchicine in preventing atrial fibrillation after cardiothoracic surgery or cardiac intervention [15][16][17][18][19][20][21][22][23].…”

Section: Search Strategy and Inclusion Criteriamentioning

confidence: 99%

“…One hundred and forty-nine articles were identified, and 9 possibly pertinent articles were chosen after a primary search. Nine studies involving 2031 patients were finally included in our analysis [15][16][17][18][19][20][21][22][23] (Fig. 1).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

A meta-analysis of colchicine in prevention of atrial fibrillation following cardiothoracic surgery or cardiac intervention

Zhao

Chen

Mao

et al. 2022

J Cardiothorac Surg

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Background Postoperative atrial fibrillation (POAF) is the most common complication after cardiothoracic surgery or cardiac intervention. Colchicine is an anti-inflammatory agent that was associated with improved cardiovascular outcomes. However, its effect on POAF prevention was inconsistent across studies. Therefore, the aim of this meta-analysis was to evaluate the efficacy of colchicine in prevention of POAF. Methods We searched PubMed, Embase, ClinicalTrials.gov, Cochrane Library database and Google Scholar for randomized controlled trials (RCTs), using terms "atrial fibrillation” and “colchicine". The primary end point was the occurrence of clinically diagnosed atrial fibrillation. The relative risk (RR) and 95% confidence interval (CI) were evaluated. Estimates were pooled using DerSimonian-Laird random-effects model. We also performed subgroup analyses based on the duration and dose of colchicine treatment. Results A total of 9 RCTs were included in this meta-analysis, enrolling a total of 2031 patients. Colchicine significantly reduces the incidence of POAF (RR 0.62; 95% CI, 0.52–0.74, P < 0.001, I2 = 0%). Subgroup analyses indicated that the protective effect of colchicine on POAF was slightly stronger in the long-duration group (RR 0.60; 95% CI, 0.48–0.75, P < 0.001, I2 = 0%) than in the short-duration group (RR 0.65; 95% CI, 0.49–0.86, P < 0.001, I2 = 0%). Conclusion Colchicine is effective in preventing the occurrence of POAF. The efficacy of colchicine can be slightly increased over treatment duration, with no obvious adverse reactions.

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“…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). Although the above-mentioned opposite outcomes may be attributed to the small sample size and early study termination, the effectiveness of colchicine in preventing AF needs to re-examination.…”

Section: Therapeutic Potential Of Targeting Immune Remodelingmentioning

confidence: 91%

Immune remodeling and atrial fibrillation

et al. 2022

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Atrial fibrillation (AF) is a highly prevalent arrhythmia that causes high morbidity and mortality. However, the underlying mechanism of AF has not been fully elucidated. Recent research has suggested that, during AF, the immune system changes considerably and interacts with the environment and cells involved in the initiation and maintenance of AF. This may provide a new direction for research and therapeutic strategies for AF. In this review, we elaborate the concept of immune remodeling based on available data in AF. Then, we highlight the complex relationships between immune remodeling and atrial electrical, structural and neural remodeling while also pointing out some research gaps in these field. Finally, we discuss several potential immunomodulatory treatments for AF. Although the heterogeneity of existing evidence makes it ambiguous to extrapolate immunomodulatory treatments for AF into the clinical practice, immune remodeling is still an evolving concept in AF pathophysiology and further studies within this field are likely to provide effective therapies for AF.

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Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial

Cited by 21 publications

References 22 publications

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

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

A meta-analysis of colchicine in prevention of atrial fibrillation following cardiothoracic surgery or cardiac intervention

Immune remodeling and atrial fibrillation

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