Rx for Heart Surgery Raised Some Concerns

Colchicine may reduce some heart surgery complications but increase risk of negative gastrointestinal effects

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) After heart surgery, a patient may experience fever, chest pain and inflammation. Colchicine has been shown to decrease those symptoms, but the medicine may lead to other complications.

Plant-based colchicine is typically used to treat gout attacks, which can cause severe pain in joints. Some initial research has suggested that colchicine may also relieve common problems related to heart surgery.

A new study found that colchicine may prevent some surgery-related complications, but it did not seem to help with irregular heartbeat or excess fluid around the heart and lungs. It may also cause gastrointestinal problems like diarrhea.

"Ask your surgeon about heart surgery complications."

The study was written by Massimo Imazio, MD, with the cardiology department at Maria Vittoria Hospital in Turin, Italy, and colleagues.

He and his colleagues set out to see how colchicine would affect postsurgery complications, which about a third of all heart surgery patients have. The study authors cited one trial that had shown colchicine to prevent these health issues.

The complications included postpericardiotomy syndrome, which causes swelling and irritation of the pericardium (the sac-like membrane around the heart).

The researchers also tracked postoperative atrial fibrillation (AF), a type of irregular heartbeat.

Also, the study authors looked for postoperative pericardial/pleural effusion. This common postsurgery problem causes too much fluid to build up around the heart and lungs.

A total of 360 cardiac surgery patients from 11 centers in Italy participated. Half the individuals received colchicine two to three days before surgery. They continued to take the medicine for one month after their operation. The other patients were given similar doses of a placebo.

Within three months of the surgery, just over 19 percent of the colchicine patients had postpericardiotomy syndrome — compared to just over 29 percent in the placebo group.

The authors reported no significant differences between the colchicine and placebo groups in regards to AF. AF occurred in almost 34 percent of colchicine group and close to 42 percent of the placebo group.

There was also no difference between the groups when it came to postoperative pericardial/pleural effusion. This occurred in 57.2 percent of the colchicine patients and 58.9 percent of the placebo-takers.

Colchicine patients had more adverse events. They included diarrhea, nausea, cramping, abdominal pain and vomiting. About 20 percent of colchicine patients had such events, while almost 12 percent of the placebo group had them.

Dr. Imazio and team concluded that colchicine significantly reduced the incidence of postpericardiotomy syndrome after heart surgery but did not reduce the risk of postoperative AF and postoperative pericardial/pleural effusions.

“The high rate of adverse effects is a reason for concern and suggests that colchicine should be considered only in well­-selected patients,” the authors wrote.

The study was published online Aug. 30 in JAMA.

One of the authors reported consulting for Servier, serving on an advisory board for Boehringer Ingelheim and receiving lecturer fees from Abbott, AstraZeneca, Merck Serono, Richter Gedeon and Teva.

Review Date: 
August 29, 2014
Last Updated:
August 31, 2014