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Trinity Vey

Tue, 11/16/2021 - 15:46

Hi Kyla,

I first want to commend you an on a great facilitated discussion and very well-written blog post! You hit all the main points from Dr. Conen’s talk which I really appreciate as someone with a limited cardiology background. In the grand round’s presentation, it was mentioned that metoprolol (beta-blockers) which are sometimes prescribed for peri-operative atrial fibrillation (POAF) inherently increase one’s risk of stroke. We rely so much on medication in the medical world, and this finding prompted me to wonder about risks associated with the other pharmacological therapies being investigated for POAF. Inevitably, certain non-vitamin K antagonist oral anticoagulants (NOAC) such as rivaroxaban are associated with risk of major bleeding (1). If patients have additional co-morbidities requiring medication, this increases the potential for adverse outcomes. Colchicine has a narrow therapeutic window with reported fatalities from 7 mg single dose administration (2). While this is much higher than the COP-AF regimen of 0.5 mg of colchicine twice daily for 10 days, over 20% of patients taking colchicine will experience diarrhea, vomiting and nausea (2). I’d imagine these symptoms could interfere with patients taking the medication twice daily. Do you think there is anything we can do to more strictly monitor or increase patient adherence during clinical trials?

I am sure that Dr. Conen’s clinical trials will further elucidate potential adverse outcomes of these medications, but it is an important reminder that all therapeutic interventions come with a cost, and that the risk-to-benefit ratio must always be considered in an individual context.

Thanks again for your great summary Kyla,

Trinity Vey

1. Pan KL, Singer DE, Ovbiagele B, Wu YL, Ahmed MA, Lee M. Effects of Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2017;6(7):e005835. Published 2017 Jul 18. doi:10.1161/JAHA.117.005835
2. Slobodnick A, Shah B, Krasnokutsky S, Pillinger MH. Update on colchicine, 2017. Rheumatology (Oxford). 2018;57(suppl_1):i4-i11. doi:10.1093/rheumatology/kex453

Trinity Vey

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