NEW YORK (Reuters Health) – A review of available evidence indicates that colchicine given after cardiac surgery reduces the risk of developing post-pericardiotomy syndrome, or PPS.

“The data suggest a beneficial profile for colchicine and open a new therapeutic strategy for prevention of PPS,” Dr. Massimo Imazio, with Maria Vittoria Hospital in Turin, Italy, and colleagues write in the American Journal of Cardiology online May 30.

The researchers note that post-pericardiotomy syndrome affects 10%-40% of cardiac surgery patients and can be mild or severe, sometimes necessitating pericardiocentesis or thoracentesis. Recently, drugs used to treat the condition have been proposed for its prevention, they explain, but there has been no systematic review of the topic.

The authors therefore identified 343 potentially relevant studies on pharmacologic primary prevention of post-pericardiotomy syndrome, which ultimately yielded four clinical trials for analysis.

One was a nonrandomized trial comparing aspirin to historical controls; the other three were double-blind randomized trials, one of methylprednisolone versus placebo, and two comparing colchicine versus placebo. (Dr. Imazio and colleagues were the authors of one of the latter. See Reuters Health report “Colchicine may prevent post-pericardiotomy syndrome” posted September 15, 2010.)

Results with aspirin and methylprednisolone were negative, with odds ratios for PPS of 1.13 and 1.00, respectively, the team found. On the other hand, they report, “Meta-analytic pooling showed that colchicine was associated with decreased risk of PPS (OR 0.38).”

They caution that colchicine has a narrow therapeutic-toxicity window and careful monitoring for possible drug interactions and side effects is necessary. “However, when appropriately used and contraindications have been excluded, oral colchicine is a safe treatment.”

Dr. Imazio and colleagues conclude that clinical evidence for primary prevention of post-pericardiotomy syndrome is still limited. “Nevertheless, this is the first meta-analysis on clinical studies on primary prevention of PPS, highlighting current knowledge and unmet needs on this important clinical topic.”

Reference:
Meta-Analysis of Randomized Trials Focusing on Prevention of the Postpericardiotomy Syndrome
Am J Cardiol 2011.