Colchicine Prevents Postoperative Atrial Fibrillation in Cardiac and Thoracic Surgery Patients: Contemporary Evidence From a Meta‐Analysis of Randomized Controlled Trials

Background Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac and thoracic surgery. Stems from atrial oxidative stress and pericardial inflammation, POAF is associated with adverse clinical outcomes such as heart failure, stroke, and increased mortality. As an anti‐inflammatory agent, colchicine has shown effective POAF risk reduction. Methods A systematic review and meta‐analysis were conducted including randomized controlled trials (RCTs) evaluating colchicine for POAF prevention till september 2025. Data were pooled using random‐effects models with restricted maximum likelihood (REML). Subgroup analyses examined treatment duration (< 2 weeks vs. > 2 weeks) and surgery type. Heterogeneity was assessed with I 2, and stability of outcomes was assessed using leave‐one‐out (LOO) analyses. Results Twelve RCTs encompassing 5637 participants were included. Colchicine significantly reduced POAF incidence compared with control (RR = 0.73; 95% CI = 0.64–0.84; p < 0.0001; I 2 = 0%). Both short‐course (< 2 weeks) and long‐course (> 2 weeks) regimens were effective without any significant subgroup difference ( p = 0.57). Colchicine increased gastrointestinal adverse events (OR = 2.25; 95% CI = 1.86–2.73) and diarrhea (RR = 3.16; 95% CI = 2.25–4.42) but showed no excess bleeding (RR = 0.89; 95% CI = 0.61–1.28), sepsis (RR = 1.32; 95% CI = 0.48–3.59), or in‐hospital mortality (RR = 0.90; 95% CI = 0.43–1.86). Funnel plots and Egger’s tests revealed no publication bias. Conclusions Colchicine achieved significant POAF risk reduction without serious adverse events. Both short‐ and long‐course regimens were effective, with the short‐course approach offering optimal tolerability. These findings support colchicine as a safe, inexpensive adjunct for POAF prevention.