What is the treatment for Dressler syndrome?

Treatment of Dressler Syndrome

Aspirin plus colchicine is the first-line treatment for Dressler syndrome, with aspirin dosed at 500-1000 mg every 6-8 hours (1.5-4 g/day) and colchicine at 0.5-0.6 mg once or twice daily for 3 months. 1, 2

First-Line Treatment

• Aspirin is the NSAID of choice for Dressler syndrome, recommended by both the American College of Cardiology and European Society of Cardiology guidelines 1, 2
• Colchicine should be added to aspirin therapy at a dose of 0.5-0.6 mg twice daily for patients ≥70 kg or 0.5 mg once daily for patients <70 kg 2
• The combination of aspirin and colchicine reduces recurrence rates by approximately 50% compared to aspirin alone 2
• Treatment duration typically ranges from several weeks to 3 months, with longer courses sometimes needed for refractory cases 1, 2

Medication Considerations

• NSAIDs other than aspirin may be used if aspirin is contraindicated, with ibuprofen being a common alternative 3
• For patients who have recently undergone coronary stenting, the combination of low-dose colchicine and acetaminophen may be considered to avoid bleeding risks associated with high-dose aspirin 4
• Glucocorticoids and non-aspirin NSAIDs are potentially harmful for treatment of pericarditis after STEMI and should be avoided as first-line therapy 1

Second-Line Treatment Options

• For patients who fail to respond to aspirin and colchicine:
  • Acetaminophen, higher doses of aspirin, or narcotic analgesics may be reasonable alternatives 1
  • Corticosteroids can be considered for refractory cases, but should be used with caution as they may delay myocardial infarction healing 2
  • Long-term oral corticosteroid therapy (3-6 months) may be necessary in severe refractory cases 2

Treatment Tapering

• Decrease aspirin/NSAID doses gradually (e.g., aspirin by 250-500 mg every 1-2 weeks) 2
• Taper one drug at a time, generally starting with the NSAID 2
• Gradually discontinue colchicine over several months in difficult cases 2

Monitoring and Follow-Up

• Patients with post-MI pericardial effusion >10 mm should be investigated for possible subacute rupture 1
• Hospitalization is recommended to observe for cardiac tamponade, establish differential diagnosis, and adjust treatment as needed 2
• Echocardiography should be performed in patients with suspected Dressler syndrome to evaluate for pericardial effusion 1
• Cardiac MRI may be useful to confirm the diagnosis by showing features of pericarditis 5

Special Considerations

• Dressler syndrome has become rare (<1% of cases) in the era of primary percutaneous coronary intervention but should still be considered in patients presenting with fever, pleuritic chest pain, and pericardial effusion 1-6 weeks after myocardial infarction 1, 6, 5
• Anticoagulation should be discontinued or used with extreme caution in the presence of a significant (≥1 cm) or enlarging pericardial effusion due to risk of hemorrhagic conversion 1
• The prognosis is generally favorable, though the syndrome can follow a relapsing course 7