NEW YORK (Reuters Health) – The risk of developing post-pericardiotomy syndrome (PPS) in cardiac surgery patients can be halved by treatment with colchicine, an international team has shown.

Dr. Massimo Imazio at Maria Vittoria Hospital in Torino, Italy and colleagues report the finding in the European Heart Journal published online August 30.

The authors note that PPS occurs days or weeks post-op in 10% to 40% of cardiac surgery patients and can prolong the hospital stay and increase costs. Complications such as cardiac tamponade can be life threatening.

Based on anecdotal reports that the antiinflammatory effects of colchicine may be useful for treating PPS, the researchers tested it for the primary prevention of PPS in a randomized clinical trial.

The study involved 360 patients undergoing cardiac surgery for angina, MI, valve disease or other conditions. They were randomized to placebo or colchicine in addition to standard therapy, beginning on the third post-op day. “Colchicine was given at the dosage of 1.0 mg twice daily for the first day followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients >70 kg, and halved doses for patients <\=70 kg or intolerant to the highest dose,” the team reports. The primary endpoint, PPS within 12 months after surgery, occurred in 8.9% of subjects in the colchicine arm and 21.1% in the placebo group (p=0.002). Colchicine also significantly reduced the secondary endpoint that included disease-related hospitalization, cardiac tamponade, constrictive pericarditis, and relapses at 18 months (0.6% vs. 5.0%; respectively). The rates of side effects and drug withdrawal were similar in the colchicine and placebo groups, with GI intolerance being the only notable side effect. In their conclusion, Dr. Imazio and colleagues say the results are “particularly important for clinical practice because the post-operative management (of PPS) may be complex, troublesome and empirical anti-inflammatory therapy may not be efficacious.” Reference:
COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial


Eur Heart J 2010