From the Guidelines
Pericarditis following myocardial infarction (MI) should be treated with aspirin and colchicine, as this combination has been shown to improve outcomes and prevent recurrence, with the most recent and highest quality evidence supporting this approach 1. The treatment of pericarditis following MI typically involves a combination of anti-inflammatory medications and supportive care.
- The use of aspirin is recommended, as it has been shown to be effective in reducing inflammation and improving symptoms 1.
- Colchicine should be added to aspirin, as it has been shown to improve outcomes and prevent recurrence, with a dose of 0.5-0.6mg twice daily for 3 months being recommended 1.
- The treatment should continue for 1-2 weeks, followed by a gradual taper over 2-4 weeks, with regular follow-up with echocardiography to monitor for pericardial effusion and ensure resolution of symptoms.
- Corticosteroids should be reserved for refractory cases or when NSAIDs are contraindicated, as they may impair myocardial healing 1. Some key points to consider in the management of pericarditis following MI include:
- The importance of monitoring for complications such as cardiac tamponade or constrictive pericarditis 1.
- The need for pain management and regular follow-up with echocardiography to monitor for pericardial effusion and ensure resolution of symptoms 1.
- The use of colchicine has been extrapolated from its efficacy in other settings, and although pericarditis is not an absolute contraindication to anticoagulation, caution should be exercised because of the potential for hemorrhagic conversion 1.
From the Research
Pericarditis Following MI
- Pericarditis is a known complication of myocardial infarction (MI), occurring in approximately 5% to 6% of patients who receive thrombolytic agents 2.
- The condition should be suspected in any patient with pleuropericardial pain, and a pericardial friction rub may or may not be present 2.
- Differentiation of pericarditis from recurrent angina may be difficult, but a careful history and evaluation of serial electrocardiograms can help distinguish the two entities 2.
Treatment of Pericarditis Following MI
- Aspirin should replace non-steroidal anti-inflammatory drugs (NSAIDs) in pericarditis complicating acute myocardial infarction 3.
- Therapy is directed toward relief of pain, which usually responds well to nonsteroidal anti-inflammatory agents (eg, aspirin or ibuprofen) 2.
- Colchicine can be used concomitantly with NSAIDs as the first-line approach, particularly in severely symptomatic cases 3.
- Systemic corticosteroids can be used in refractory cases or in those with immune-mediated etiologies, although generally should be avoided due to a higher risk of recurrence 3.
Prevention of Recurrences
- Colchicine is the mainstay of treatment in acute and recurrent pericarditis, and is effective in reducing the risk of recurrent pericarditis 4.
- Anti-interleukin-1 agents (anakinra, rilonacept) are a valuable option in case of recurrent pericarditis refractory to conventional drugs 4.
- A correct pharmacological management of pericarditis is key to prevent recurrences, and understanding appropriate treatment will assist the clinician in helping decrease the risk of recurrent, incessant, and refractory pericarditis 5.