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COPPS-POAF: Colchicine halved AF incidence after surgery
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AHA Scientific Sessions 2011
ORLANDO, Fla. — Late-breaking data from the COPPS-POAF trial demonstrate that colchicine was safe and effective in reducing postoperative atrial fibrillation. According to Massimo Imazio, MD, the drug has the potential to halve complications and reduce hospitalizations.
Imazio presented results of the trial — simultaneously published in Circulation — at a press conference here.
“Following cardiac surgery, colchicine, as an empiric anti-inflammatory therapy, appears to be an inexpensive and safe means to reduce the incidence of postoperative AF and hospitalization length, and also reduce the incidence of the postpericardiotomy and postoperative effusions,” Imazio said.
Colchicine reduced AF incidence by nearly half 1 month after surgery (P=.021).
COPPS-POAF included 336 patients (mean age, 65 years) from COPPS, a multicenter, double blind, randomized trial. Randomization included twice-daily placebo or colchicine 1 mg beginning on the third day after surgery, followed by a twice-daily maintenance dose of 0.5 mg for 1 month in those who weighed more than 70 g; the dose was halved for those ≤70 kg or who were intolerant to the highest dose. The primary endpoint was incidence of postoperative AF (POAF) at 1 month.
Compared with placebo, colchicine treatment was associated with a decreased incidence of POAF (22% vs. 12%; P=0.021) and shorter duration of POAF (7.7 days vs. 3 days; P<.001). Patients assigned to colchicine also had shorter hospital lengths of stay (9.4 vs. 10.3; P=.040) and rehabilitation stay (12.1 vs. 13.9 days; P=.009).
Adverse effects were similar between the two groups, according to Imazio, although there was a nonsignificant trend toward more gastrointestinal disturbances (diarrhea) in the group receiving colchicine. There was no incidence of death or stroke in either arm. The researchers noted a nonsignificant trend toward more gastrointestinal disturbances in the group receiving colchicines.
Ongoing research on the topic will include a trial to be started at the beginning of next year (COPPS-2) to test the efficacy and safety of colchicine given at least 24 hours before cardiac surgery for the combined prevention of postpericardiotomy syndrome, postoperative AF and postoperative effusions. – by Stacey L. Fisher
For more information:
- Imazio M. LBCT.05. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
- Imazio M. Circulation. 2011;doi:10.1161/CIRCULATIONAHA.111.026153
Disclosure: Dr. Imazio reports no relevant financial disclosures.
Future directions for further research that I would like to see would include enrolment of patients into larger, multicenter, multiethnic, randomized trials to confirm both the safety and efficacy of colchicine. Another potential area of study may be earlier administration of colchicine — for example, starting in the preoperative period — to test whether the incidence of preoperative AF could be further reduced. Finally, if not used prophylactically, colchicine therapy as adjunct treatment for postoperative AF once it develops is another possibility to be studied.
Nancy A. Nussmeier, MD
Professor of
Anesthesiology
Upstate Medical University at the State University of New
York
Disclosure: Dr. Nussmeier is a consultant for/on the advisory board of Merck (executive committee for Acadesine study).
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