Short-Term, Weight-Adjusted Colchicine to Prevent Post-CABG Arrhythmias: A Randomized, Double-Blind, Controlled Trial

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Postoperative arrhythmias are frequent complications following coronary artery bypass graft (CABG) surgery, associated with increased adverse outcomes.
• Previous studies on colchicine for preventing these arrhythmias yielded inconsistent results, potentially due to variations in dosage and administration timing.

Purpose of the Study:

• To assess the efficacy and safety of a short-term, weight-adjusted colchicine regimen initiated preoperatively for the prevention of postoperative arrhythmias in patients undergoing CABG.
• To investigate the impact of colchicine on both early and late postoperative atrial fibrillation (POAF) and other arrhythmias.

Main Methods:

• A randomized, double-blind, placebo-controlled trial involving 172 adult patients scheduled for on-pump CABG.
• Patients received either colchicine or a placebo, with colchicine administered as a preoperative loading dose followed by a weight-based daily maintenance dose for 14 days.
• The primary endpoint was the incidence of postoperative atrial fibrillation (POAF); secondary endpoints included other arrhythmias, inflammatory markers, hospital stay, and adverse events.

Main Results:

• Colchicine significantly reduced the incidence of POAF compared to placebo (17.3% vs. 46.3%), with a number needed to treat (NNT) of 4.
• The reduction in POAF was observed for both early and late occurrences.
• Gastrointestinal events, mainly diarrhea, were more frequent in the colchicine group but were manageable and not associated with serious adverse events.

Conclusions:

• Short-term, perioperative, weight-adjusted colchicine is an effective and safe strategy for preventing POAF after CABG.
• The treatment shows a favorable NNT and acceptable side effect profile.
• Colchicine did not demonstrate a significant effect on other types of postoperative arrhythmias.