Key result
Treatment with colchicine (0.5 mg/day) and acetaminophen (2000 mg/day) led to clinical improvement and hospital discharge in a 69-year-old man with Dressler's syndrome.
Why the study?
Guidelines recommend high-dose aspirin for Dressler's syndrome based on pre-PCI evidence, but bleeding and thrombotic concerns complicate high-dose aspirin use after recent coronary stenting.
Does combination therapy of colchicine and acetaminophen improve symptoms in a patient with Dressler's syndrome after recent coronary stenting?
Case Report (n=1)
Does combination therapy of colchicine and acetaminophen improve symptoms in a patient with Dressler's syndrome after recent coronary stenting?
Combination therapy of low-dose colchicine and acetaminophen could be a viable treatment option for Dressler's syndrome in patients with recent coronary stenting, avoiding the bleeding and thrombotic risks associated with guideline-recommended high-dose aspirin.
Answers are grounded in this paper and cite their sources.
Case suggests caution with high-dose aspirin post-stenting in Dressler's syndrome; leaves open optimal therapy in the reperfusion era.
The incidence of Dressler's syndrome after myocardial infarction (MI) has decreased in the reperfusion therapy era. Although guidelines recommend high-dose aspirin for treatment based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era, bleeding and thrombotic concerns occurred upon aspirin administration after coronary stenting. A 69-year-old man with recent MI was admitted to our hospital. The patient presented with chest pain 1 week before admission. Electrocardiography revealed newly detected atrial fibrillation with no ST segment change. Urgent coronary angiography demonstrated a left circumflex artery occlusion. He underwent PCI, and a sirolimus-eluting stent was deployed. Aspirin, prasugrel, and apixaban were administered. However, hospital discharge was delayed because he developed heart failure during hospitalization. Twenty-three days after admission, he developed a fever of >39 °C. Electrocardiography showed anterior ST segment elevation, and echocardiography revealed a 6-mm pericardial effusion. We diagnosed the patient with Dressler's syndrome, and colchicine 0.5 mg/day + acetaminophen 2000 mg/day were administered. His condition clinically improved after treatment and he was discharged 32 days after admission. There was hesitation about administration of high-dose aspirin in a patient who has undergone recent coronary stenting. Combination therapy of colchicine and acetaminophen could be a treatment option for Dressler's syndrome. < Learning objective: Guidelines recommend high-dose aspirin for the treatment of Dressler's syndrome based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era. However, bleeding and thrombotic concerns are present upon high-dose aspirin administration in patients who have undergone PCI. Therefore, a combination therapy of low-dose colchicine and acetaminophen could be a treatment option for patients with Dressler's syndrome who have undergone recent coronary stenting.>
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Nomoto et al. (2020) conducted a case report in Dressler's syndrome (n=1). Colchicine and acetaminophen was evaluated on Clinical improvement. Treatment with colchicine (0.5 mg/day) and acetaminophen (2000 mg/day) led to clinical improvement and hospital discharge in a 69-year-old man with Dressler's syndrome.
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