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Efecto de la colchicina en la fibrilación auricular perioperatoria y la lesión del miocardio después de cirugía no
David Conen1, Michael Ke Wang2, Ekaterine Popova3
1Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Lancet (London, England)
|August 28, 2023
Resumen
La colchicina no redujo significativamente la fibrilación auricular perioperatoria o la lesión miocárdica después de una cirugía no cardíaca (MINS). Sin embargo, aumentó el riesgo de diarrea no infecciosa en pacientes sometidos a cirugía torácica.
Área de la Ciencia:
- Cardiología
- Farmacología
- Resultados quirúrgicos
Sus antecedentes:
- Los biomarcadores inflamatorios se correlacionan con un mayor riesgo de fibrilación auricular perioperatoria y lesión miocárdica después de cirugía no cardíaca (MINS).
- La colchicina, un agente antiinflamatorio, fue investigado por su potencial para mitigar estas complicaciones quirúrgicas.
Objetivo del estudio:
- Evaluar la eficacia de la colchicina oral en la reducción de la incidencia de la fibrilación auricular perioperatoria clínicamente importante y el MINS.
- Evaluar el perfil de seguridad de la colchicina, incluidos los riesgos de sepsis, infección y diarrea no infecciosa.
Principales métodos:
- Un ensayo aleatorizado, doble ciego, controlado con placebo (COP-AF) en el que participaron 3209 pacientes mayores de 55 años sometidos a cirugía torácica mayor no cardíaca.
- Los pacientes recibieron colchicina oral (0,5 mg dos veces al día) o placebo durante 10 días, comenzando antes de la operación.
- Los resultados co-primarios fueron la fibrilación auricular perioperatoria clínicamente importante y el MINS dentro de los 14 días; los resultados de seguridad incluyeron infección y diarrea.
Principales resultados:
- La fibrilación auricular clínicamente importante se produjo en el 6,4% del grupo de colchicina frente al 7,5% del grupo de placebo (HR 0,85; p=0,22).
- MINS se produjo en el 18,3% del grupo de colchicina frente al 20,3% del grupo de placebo (HR 0,89; p=0,16).
- La diarrea no infecciosa fue significativamente más frecuente en el grupo de colchicina (8,3%) en comparación con el placebo (2,4%).
Conclusiones:
- La administración de colchicina no disminuyó significativamente las tasas de fibrilación auricular perioperatoria o MINS en pacientes sometidos a cirugía torácica mayor no cardíaca.
- El uso de colchicina se asoció con una mayor incidencia de diarrea no infecciosa, un efecto secundario en su mayoría benigno.
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