Abstract
Background
Atrial fibrillation occurs frequently after open-heart surgery. It is associated with
increased morbidity and mortality, longer hospital stays, and increased healthcare
costs. Prophylactic administration of colchicine may mitigate post-operative atrial
fibrillation (POAF).
Methods
We searched PubMed, ClinicalTrials.gov and CENTRAL databases to identify randomized controlled trials (RCTs) that; (1) compared
prophylactic use of colchicine to placebo, or usual care, in patients with sinus rhythm
who underwent elective open-heart surgery and (2) reported POAF-incidence. We excluded
trials focused on incidence of atrial fibrillation after percutaneous interventions
or colchicine treatment of diagnosed pericarditis or post-pericardiotomy-syndrome.
A random-effects model was used to pool data for POAF-incidence as the primary outcome
and for drug-related adverse effects, major adverse events (death and stroke), and
hospital length-of-stay as secondary outcomes.
Results
We included five RCTs (1412 patients). Colchicine treatment reduced POAF-events by
30% versus placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95% confidence
interval (CI) 0.57 to 0.84, p = 0.0002). Adverse drug-related effects, especially gastrointestinal intolerance, increased
with colchicine; (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p < 0.0001). However, major adverse events were unchanged (3.2% vs. 3.2%, RR 0.96, 95%
CI 0.48 to 1.95, p = 0.92). Length-of-stay decreased by 1.2 days with colchicine (95% CI -1.89 to −0.44, p = 0.002).
Conclusion
Colchicine demonstrated superior efficacy versus usual care for prevention of atrial
fibrillation after cardiac surgery. Moreover, colchicine treatment was associated
with shorter hospital stays. These benefits outweigh increased risk of adverse drug-related
effects; although further work is needed to minimize gastrointestinal effects.
Keywords
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Article info
Publication history
Published online: August 30, 2017
Accepted:
August 14,
2017
Received in revised form:
July 7,
2017
Received:
April 20,
2017
Footnotes
☆These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
☆☆Registration: PROSPERO CRD42016046010 https://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42016046010.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
