Prevention of the postpericardiotomy syndrome, postoperative effusions, and atrial fibrillation after cardiac surgery, efficacy and safety of colchicine: evidence from the COPPS trial and substudies

Colchicine has been recently demonstrated to be efficacious and safe for the prevention of several postoperative complications including the postpericardiotomy syndrome (PPS), postoperative pericardial and pleural effusions, and postoperative atrial fibrillation according to the results of the COPPS trial. The aim of the present paper is to critically review the premise, results and implications of this trial for current clinical practice and future research. The COPPS study is a multicenter, double-blind, randomized trial. On the third postoperative day, 360 patients (mean age 65.7 ± 12.3 years, 66% males) were randomized to receive placebo or colchicine (1.0 mg twice daily for the first day followed by 0.5 mg twice daily for 1 month in patients ≥70 kg, and halved doses for patients <70 kg or intolerant to the highest dose). Colchicine significantly reduced the incidence of the PPS at 12 months [relative risk reduction (RRR) 58%; number needed to treat (NNT) 8], postoperative pericardial (RRR 43.9%; NNT 10) and pleural effusions (RRR 52.3%; NNT 8) as well as the incidence of postoperative atrial fibrillation (RRR, 45%; NNT 11) with similar side effects in the study groups. Colchicine is a promising drug for the prevention of several postoperative complications (PPS, postoperative effusions and postoperative atrial fibrillation) based on its anti-inflammatory effects and good tolerability at the study doses. Although further studies are needed before routine recommendation of the drug will be possible for patients undergoing cardiac surgery, colchicine seems to have the potentiality of becoming a new therapeutic standard in the perioperative period.