The effect of colchicine on the echocardiographic constrictive physiology after coronary artery bypass graft surgery

Abstract

Background Constrictive physiology is a transitory condition that could lead to constrictive pericarditis, which is a rare complication after open‐heart surgery. Anti‐inflammatory drugs like colchicine are recommended for prevention of constrictive pericarditis; however, there is no evidence about the effect of colchicine on constrictive pericarditis. Thus, the aim of this study is to evaluate the preventive effect of colchicine on the incidence of echocardiographic constrictive physiology after open‐heart surgery. Methods This was a parallel randomized, double‐blind trial. Patients were randomly assigned to receive 1 mg colchicine once‐daily from 48 hours before and 0.5 mg twice daily for 5 days after surgery. Primary outcome was the incidence of the constrictive physiology after primary endpoint (1 week after the surgery). The secondary outcome was the primary outcome after secondary endpoint (4 weeks after surgery) plus the new cases of constrictive physiology between the primary and secondary endpoints. Results Out of 160 participating patients, the primary outcome occurred in 19 patients (23%) in placebo and 11 (13%) in intervention groups. There was no significant difference between two groups (P = .106). After 4 weeks of follow‐up, 19 patients (23%) in placebo and 9 (11%) in intervention groups had constrictive physiology whereas 2 out of 11 patients (18.2%) were recovered. The difference was significant (P = .038). No new case of constrictive physiology occurred between primary and secondary endpoints. Conclusion Short‐term use of colchicine has a preventive effect on reducing constrictive physiology after 1 month of open‐heart surgery but not a week after that.

Benefits and adverse effects of hydroxychloroquine, methotrexate and colchicine: searching for repurposable drug candidates

“…It has been postulated that the modulation of atrial fibrosis by colchicine is mediated by its effects on interleukin-17 and renin-related pathways [ 51 ]. In a trial of patients undergoing coronary artery bypass grafting, perioperative treatment with colchicine was associated with reduction in post-surgical constrictive pericarditis [ 52 ]. In a rat model of hypertension induced by nephrectomy, treatment with colchicine ameliorated both glomerular and interstitial fibrosis in the remaining kidney [ 53 ].…”

Updates on the Global Prevalence and Etiology of Constrictive Pericarditis: A Systematic Review

“…There are 2 reports from the National Inpatient Sample, however these registries refer exclusively to patients from North America, and do not provide extensive information regarding the medical history of the patients and the primary etiology of their disease. 2,22 In our search, we identified only 2 published randomized clinical trials, 23,24 while case reports and small case series comprised a substantial portion of the available literature. Their overrepresentation further mandates the need for a systematic search to identify the true trends of this disease.…”

Colchicine — From rheumatology to the new kid on the block: Coronary syndromes and COVID-19

“…A meta-analysis of 6 randomized clinical trials by Salih et al [ 20 ] involving 1257 patients also demonstrated the efficacy of colchicine in reducing the risk of post-operative AF (OR 0.52; 95% CI 0.40–0.68; p < 0.001) [ 20 ]. An interesting randomized, double-blind, placebo-controlled study by Shojaeifard et al [ 21 ] assessed the efficacy of colchicine in the prevention of acute pericarditis (through its influence on constrictive physiology) after cardiac surgery. Patients (n = 160) were randomized to receive colchicine at a dose of 1 mg/day from 48 hours before and 0.5 mg twice/day for 5 days after surgery.…”

“…There was no new case of constrictive physiology between weeks 1 and 4 of observation. Thus, the short-term use of colchicine was preventative in reducing constrictive physiology after 1 month of open-heart surgery, but not after a week [ 21 ].…”