Grant: Project Grant

The development of atrial fibrillation (AF) during or shortly after major thoracic surgery is one of the most common serious complications in this patient population. The occurrence of AF leads to adverse changes in blood pressure, problems with the management of blood thinners required in many of these patients, prolonged hospital stays and an increased risk of death and stroke. Prior studies suggest that inflammation is the primary mechanism for AF developing during or after surgery. Colchicine is a potent drug that strongly inhibits inflammation. In patients undergoing cardiac surgery colchicine has been effective in preventing inflammatory complications and AF. Based on these findings, we hypothesize that colchicine effectively prevents the occurrence of AF in patients undergoing major thoracic surgery. In this population, colchicine may also reduce the time to chest tube extraction, an important patient-centered outcome, as it may shorten hospital stay, reduce the incidence of postoperative infections and improve patient's well-being. Colchicine administration may even reduce the occurrence of death or stroke. To test these hypotheses, we will conduct a large double-blind randomized placebo controlled trial of 2,800 patients who are at least 55 years old and undergoing thoracic surgery. The trial will be conducted in thoracic centres in Canada and internationally. Oral colchicine or matching placebo will be given twice daily for 10 days. Study personnel will follow patients throughout the trial. This large trial will determine whether colchicine lowers the risk of AF and other inflammatory complications in patients undergoing thoracic surgery. Finding a safe, effective and low-cost intervention to prevent AF in this setting addresses a major unmet clinical need as it may decrease length of hospital stay, improve the quality of perioperative care, lower costs and reduce the risk of stroke or death.