Learning Points

• Pericardial Effusions–Indications for a pericardiocentesis
  • Hemodynamically unstable (therapeutic)
  • Hemodynamically stable (diagnostic):
    • If suspicious of Purulent, TB, Neoplastic pericarditis
    • Mod-large effusion s/p failed anti-inflammatory tx
• Treatment:
  • COPE Study: Results of the COlchicine for acute PEricarditis (Imazio in Circulation 2005)
    • Colchicine + Conventional Tx (NSAIDS) = Less Recurrence than Conventional Tx alone for the FIRST episode of acute pericarditis
  • Comprehensive systematic review on pharmacologic treatments for acute or recurrent pericarditis. (Lotrionte in AHJ 2010)
    • Colchicine vs standard tx(NSAIDS) (3 studies, 265 patients) Colchicine assoc with reduced risk of tx failure and recurrence
    • Steroids vs standard tx (2 studies, 31 patients): Steroids assoc with high risk of recurrence
  • A Randomized Trial of Colchicine for Acute Pericarditis: (Imazio in NEJM 2013)
    • Multicenter, double-blind trial, randomized; 240 patients
    • Colchicine + conventional tx significantly reduced  rate of recurrent pericarditis