AHA 09: the POPE study

Hospitalists involved in the care of CABG patients will find this study of interest. Pericardial irritation occurs post CABG. Pericarditis can cause arrhythmias as well as lead to effusion progressing to tampanade. Frequently NSAIDs are given to reduce these complications. Evidence to support this strategy has been lacking. The POPE study, presented at AHA 09, looked at the use of diclofenac to reduce the volume of pericardial effusion. The findings, from the press release:

A non-steroidal anti-inflammatory drug, diclofenac, failed to reduce fluid accumulation around the heart after cardiac surgery.

The NSAID after heart surgery also did not reduce the serious problem of cardiac tamponade, compression of the heart by fluid.

Only patients with pericardial effusion at baseline were enrolled. The investigators concluded:

The use of NSAIDs in post-cardiac surgery patients is useless in this setting.

As pointed out in the presentation slides NSAID use post CABG has been common even though not supported by good evidence, and in spite of known adverse effects including increased renal failure, heart failure and myocardial infarction.