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

Shvartz, Vladimir A.; Le, T. G.; Kryukov, Yu.Yu.; Sokolskaya, Maria; Ispiryan, Artak; Khugaeva, Eleonora; Yurkulieva, G.A.; Shvartz, Elena; Petrosyan, Andrey; Bockeriа, L.A.; Bockeria, O.L.

doi:10.3390/jcm11051387

Cited by 8 publications

(14 citation statements)

References 23 publications

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“…Some clinical studies and meta analyses favor the use of colchicine to prevent postoperative atrial fibrillation (2,14,(22)(23)(24), while others do not (25)(26)(27)(28). In recent years, several new clinical trials on colchicine have been conducted and reported (29)(30)(31). In our study, we focus on the available RCTs to evaluate the efficacy and safety of colchicine in prevention of post-operative AF (2,14,22,23,(25)(26)(27)(29)(30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

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Colchicine for prevention of post-operative atrial fibrillation: Meta-analysis of randomized controlled trials

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThis study intended to assess the efficacy of colchicine for prevention of post-operative atrial fibrillation (AF).BackgroundPost-operative AF is a common complication of surgery operations. Inflammation plays a crucial role in the pathogenesis of post-operative AF. Colchicine, a potent anti-inflammatory drug, may have a role in mitigating the incidence of post-operative AF.MethodsWe searched Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), Database of Chinese sci-tech periodicals (COVIP), and Wanfang Database for randomized controlled trials (RCTs) comparing colchicine versus placebo, or usual care for prevention of post-operative AF. The main outcome was the occurrence of AF post operation, which includes cardiac surgery, lung surgery, or pulmonary vein isolation. The estimated risk ratio (RR) for the occurrence of post-operative AF was evaluated using a random-effects model. The safety end point was the development of any side effects.ResultsA total of 12 RCTs with 2274 patients were eventually included in this meta-analysis, where 1141 patients received colchicine and 1133 patients received placebo or usual care. Perioperative colchicine treatment was related to a decreased incidence of post-operative AF (RR: 0.65; 95% confidence interval [CI]: 0.56 to 0.75, p<0.001). Although the incidence of gastrointestinal side effects was increased with colchicine therapy when compared to placebo (RR = 2.49, 95% CI 1.85 to 3.34, p < 0.001), the incidence of major adverse events was not increased (RR = 0.86, 95% CI 0.46 to 1.60, p = 0.64).ConclusionIn conclusion, the results of our meta-analysis suggest that colchicine treatment could lower the incidence of post-operative AF. Further studies are needed to determine the optimal colchicine treatment regime to minimize the incidence of adverse events.

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Section: Introductionmentioning

confidence: 99%

“…In recent years, several new clinical trials on colchicine have been conducted and reported (29)(30)(31). In our study, we focus on the available RCTs to evaluate the efficacy and safety of colchicine in prevention of post-operative AF (2,14,22,23,(25)(26)(27)(29)(30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

Colchicine for prevention of post-operative atrial fibrillation: Meta-analysis of randomized controlled trials

et al. 2022

Front. Cardiovasc. Med.

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“…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 ].…”

Section: Methodsmentioning

confidence: 99%

Colchicine in Cardiac Surgery: The COCS Randomized Clinical Trial

Shvartz

Энгиноев

et al. 2022

JCDD

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Background. In patients who underwent cardiac surgery, first-time postoperative atrial fibrillation (POAF) is associated with increased incidence of hospital-acquired complications and mortality. Systemic inflammation is one of confirmed triggers of its development. The anti-inflammatory properties of colchicine can be effective for the POAF prevention. However, the results of several studies were questionable and required further investigation. Hence, we aimed to evaluate the effectiveness of low-dose short-term colchicine administration for POAF prevention in patients after the open-heart surgery. This double-blind randomized placebo-controlled trial included 267 patients, but 27 of them dropped out in the course of the study. Study subjects received the test drug on the day before the surgery and on postoperative days 2, 3, 4 and 5. The rhythm control was conducted immediately after the operation and until the discharge from the hospital. The final analysis included 240 study subjects: 113 in the colchicine group and 127 in the placebo group. POAF was observed in 21 (18.6%) patients of the colchicine group vs. 39 (30.7%) control patients (OR 0.515; 95% Cl 0.281–0.943; p = 0.029). We observed no statistically significant differences between the patient groups in the secondary endpoints of the study (hospital mortality, respiratory failure, stroke, bleeding, etc.). For other parameters characterizing the severity of inflammation (pericardial effusion, pleural effusion, WBC count, neutrophil count), there were statistically significant differences between the groups in the early postoperative period (days 3 and 5). Also, statistically significant differences between the groups in the frequency of adverse events were revealed: the incidence of diarrhea in the colchicine group was 25.7% vs. 11.8% in the placebo group (OR 2.578; 95% Cl 1.300–5.111; p = 0.005); for abdominal pain, incidence values were 7% vs. 1.6%, correspondingly (OR 4.762; 95% Cl 1.010–22.91; p = 0.028). Thus, there were statistically significant differences between groups in the primary endpoint, thereby confirming the effectiveness of short-term colchicine use for the POAF prevention after coronary artery bypass grafting and/or aortic valve replacement. Also, we detected statistically significant differences between groups in the frequency of side effects to colchicine: diarrhea and abdominal pain were more common in the colchicine group. This clinical trial is registered with ClinicalTrials database under a unique identifier: NCT04224545.

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“…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).…”

Section: Therapeutic Potential Of Targeting Immune Remodelingmentioning

confidence: 97%

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

Cited by 8 publications

References 23 publications

Colchicine for prevention of post-operative atrial fibrillation: Meta-analysis of randomized controlled trials

Colchicine for prevention of post-operative atrial fibrillation: Meta-analysis of randomized controlled trials

Colchicine in Cardiac Surgery: The COCS Randomized Clinical Trial

Immune remodeling and atrial fibrillation

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