COPPS-2

COlchicine for Prevention of the Post-Pericardiotomy Syndrome and Post-operative Atrial Fibrillation 2

Patient / Population Intervention / Exposure Comparison Outcome

In 360 patients scheduled for cardiac surgery, perioperative colchicine started before surgery and continued for 1 month reduced postpericardiotomy syndrome within 3 months compared with placebo, but did not prevent postoperative atrial fibrillation.

360

Design

Double-blind, placebo-controlled RCT

Endpoint

Postpericardiotomy syndrome within 3 months

Relevance

Result19.4 % vs 29.4 % (absolute difference 10.0 %; 95 % CI 1.1–18.7; NNT 10). No benefit for postoperative atrial fibrillation (33.9 % vs 41.7 %). Adverse events 20.0 % vs 11.7 %, driven by gastrointestinal intolerance.

Imazio M, Brucato A, Ferrazzi P, et al. JAMA. 2014;312(10):1016-1023. 10.1001/jama.2014.11026

Discussion & critique

The preoperative start caused substantial gastrointestinal dropout, so the intention-to-treat benefit is smaller than in the earlier COPPS trial. It is the largest randomised evidence for colchicine prophylaxis after cardiac surgery and explains why it is endorsed for postpericardiotomy syndrome but not for postoperative atrial fibrillation.