POPE: Diclofenac ineffective at reducing pericardial effusion

American Heart Association Scientific Sessions 2009

Diclofenac was not effective at treating moderate to severe pericardial effusion in patients following cardiac surgery and researchers recommend discontinuing use, according to data presented today from the POPE trial.

“Our results confirm that moderate to severe pericardial effusion is a very serious condition as 10% of these patients will require pericardial drainages in the two weeks following surgery,” Philippe Meurin, MD, cardiologist in Villeneuve Saint Denis, France, said during a press conference.

Meurin and colleagues set out to assess whether or not diclofenac was effective at reducing post operative pericardial effusion volume in 196 patients with fluid around the heart within one month following cardiac surgery.

Patients were randomly assigned to diclofenac 100 mg daily or placebo for 14 days.

After 14 days of treatment, data indicated a mean pericardial effusion grade decrease of -1.08 in patients assigned to placebo vs. -1.36 patients assigned to diclofenac (P=.15). “NSAID administration seems to be useless in this clinical setting,” Meurin concluded. – by Jennifer Southall

Meurin P. LBCT.03. Presented at: the American Heart Association 2009 Scientific Session; Nov. 14-18; Orlando, Fla.

Over the course of three years, the researchers screened patients who had cardiac surgery and identified 262 who had a post-operative pericardial effusion. I was disappointed because we have an infrequent but serious problem and there was data showing the NSAID was ineffective. However, I was relieved because the researchers here are saying that it is not a good thing to give NSAIDs to patients who have ischemic heart disease or are at risk for ischemic heart disease. So I am left with avoiding NSAID in patients who have ischemic heart disease and am disturbed as a physician because I am unsure of what to do with these patients. .

– Elliott Antman, MD

Brigham and Women’s Hospital, Boston