Acute Pericarditis

Diagnosed by having at least 2 of 4 of the following criteria:

1. Typical chest pain
2. Diffuse PR depression and ST segment elevation (typical ECG changes)
3. Pericardial friction rub
4. New or worsening pericardial effusion

Management of Acute Pericarditis

Colchicine

The COPE/ICAP study was an RCT (N=240) examining colchicine (0.5 mg BID x 3 months if over 70 kg, 0.5 mg OD for patients ≤70 kg) vs placebo for patients with acute pericarditis who were also treated with ASA or ibuprofen. The primary outcome of incessant or recurrent pericarditis occurred in 17% vs 38% (RRR 0.56, NNT 4), reduced the symptom persistence at 72 hours (19% vs 40%), and remission rate at 1 week (85% vs 58%). No increase of adverse effects.

Glucocorticoid therapy (0.2 to 0.5 mg of prednisone per kilogram of body weight per day for 2 weeks with gradual tapering) was administered to patients with contraindications to aspirin and ibuprofen (i.e., allergy, history of peptic ulcer or gastrointestinal bleeding, or use of oral anticoagulant therapy when the bleeding risk was considered high or unacceptable) or a history of side effects. All patients received a proton-pump inhibitor for gastroduodenal prophylaxis.