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Colchicine Anti-inflammatory drug used for centuries for the treatment of gout

Colchicine Reduces Postoperative Atrial Fibrillation Imazio M, Brucato A, Ferrazzi P, et al. for the COPPS Investigators (Discussant: Nancy A. Nussmeier, M.D.). Colchicine Anti-inflammatory drug used for centuries for the treatment of gout

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Colchicine Anti-inflammatory drug used for centuries for the treatment of gout

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  1. Colchicine Reduces Postoperative Atrial FibrillationImazio M, Brucato A, Ferrazzi P, et al. for the COPPS Investigators(Discussant: Nancy A. Nussmeier, M.D.) Colchicine • Anti-inflammatory drug used for centuries for the treatment of gout • Only recently reviewed and approved by the FDA – in 2009 • Also beneficial in the treatment and secondary prevention of pericarditis • Mechanism not entirely understood • Related to capacity to disrupt microtubules by binding β-tubulin • Inhibition of leukocyte function by this mechanism (anti-inflammation) Postoperative Atrial Fibrillation (POAF) • Most common complication after cardiac surgery (27-40% incidence) • Causes - inflammation, excess catecholamines, hemodynamic factors • Increased incidence of CHF, renal insufficiency, stroke, increased duration of hospital stay and readmission rate 0

  2. Colchicine Reduces Postoperative Atrial FibrillationImazio M, Brucato A, Ferrazzi P, et al. for the COPPS Investigators A substudy of the “Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) Trial” Purpose: To test the hypothesis that colchicine may prevent postop atrial fibrillation (POAF) Design: Colchicine (1.0 mg bid x 1 day, then 0.5 mg bid) or placebo administered for 1 month, commencing on POD #3 360 patients enrolled in 6 hospitals in Italy 336 patients analyzed (after exclusions for chronic preop AFib and for development of AFib prior to randomization on POD #3) 1° Endpoint: POAF - 22.0% in placebo patients vs. 12.0% in colchicine patients (p=0.021) 2° Endpoints: Hospital Stay ~ 1 day shorter in colchicine patients (p=0.04) No difference in death or stroke Side Effects: Nonsignificant trend toward more GI distress (diarrhea) in colchicine patients (p=0.082)

  3. Colchicine Reduces Postoperative Atrial Fibrillation Implications Colchicine, administered prophylactically as an anti-inflammatory therapy, appears to halve the incidence of POAF after cardiac surgery Potentially a cheap, effective, and relatively safe option for decreasing the incidence of PPS and POAF

  4. Colchicine Reduces Postoperative Atrial Fibrillation Strengths First trial to show evidence of colchicine efficacy for specific prevention of POAF Well-designed - randomized, double-blind, prospective placebo-controlled, multicenter clinical trial Practical, useful implications – relatively safe, inexpensive, attractive option Weaknesses / Limitations Relatively small sample size Relatively healthy adult Caucasian population Colchicine started on POD #3 GI intolerance may limit use

  5. Colchicine Reduces Postoperative Atrial Fibrillation Future Research Larger multicenter trials to confirm efficacy (including other ethnic and age groups) Earlier administration of colchicine (starting preop) for prophylaxis against POAF? Colchicine as an adjunct for treatment and prevention of recurrence of POAF after it develops?

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