What is the recommended dose of colchicine for post-operative pericarditis?

Colchicine Dosing for Post-Operative Pericarditis

For post-operative pericarditis with confirmed systemic inflammation, use weight-adjusted colchicine dosing: 0.5 mg once daily for patients <70 kg or 0.5 mg twice daily for patients ≥70 kg, continued for 3 months. 1

Key Principle: Inflammation Must Be Present

• Colchicine is NOT recommended for postoperative effusions in the absence of systemic inflammation 1
• The diagnosis of post-cardiac injury syndrome (PCIS) requires at least 2 of 5 criteria: fever without alternative cause, pericarditic/pleuritic chest pain, pericardial/pleural rubs, pericardial effusion, or pleural effusion with elevated CRP 1
• Demonstration of inflammatory activity (elevated CRP) is essential before initiating treatment 1

Treatment Regimen

Dosing Schedule

• Weight-based dosing: 0.5 mg once daily if <70 kg; 0.5 mg twice daily if ≥70 kg 1, 2
• Duration: 3 months of treatment 1, 2
• Tapering: Not mandatory, but may consider 0.5 mg every other day (<70 kg) or 0.5 mg once daily (≥70 kg) in final weeks 1

Combination Therapy

• Colchicine should be added to aspirin (750-1000 mg every 8 hours) or ibuprofen (600 mg every 8 hours) 1, 2
• NSAIDs are generally not indicated for asymptomatic post-surgical effusions and may increase side effect risk 1
• The same therapeutic scheme used for acute pericarditis is efficacious for post-cardiac injury syndromes 1

Evidence for Efficacy

Prevention Data

• Meta-analysis of RCTs showed colchicine reduced post-pericardiotomy syndrome risk (OR 0.38) 1
• The COPPS trial demonstrated colchicine reduced PPS incidence from 21.1% to 8.9% (number needed to treat = 8) 3
• Perioperative colchicine use was effective but associated with increased gastrointestinal side effects compared to postoperative use 1

Treatment Data

• For established post-operative pericarditis, colchicine improves remission rates and reduces recurrence risk 1
• The CORP trial showed colchicine reduced recurrence from 55% to 24% in recurrent pericarditis (NNT = 3) 4

Critical Caveats

When NOT to Use Colchicine

• Asymptomatic postoperative effusions without systemic inflammation 1
• Simple mechanical consequences of surgery (pericardial/pleural effusion) without inflammatory markers 1
• Perioperative prevention in absence of inflammation (not recommended due to GI side effects without clear benefit) 1

Side Effects

• Gastrointestinal intolerance is the primary side effect (8-9% discontinuation rate) 4, 3
• Overall adverse event rate is acceptable and similar to placebo in most trials 4, 3
• Number needed to harm is 12, which is favorable compared to NNT of 3-10 5

Monitoring

• Use CRP to guide treatment length and assess response 1, 2
• Continue treatment until complete symptom resolution and CRP normalization 2
• Monitor for recurrence, which occurs in <4% of post-pericardiotomy syndrome cases 1