Why colchicine is not beneficial in patients with acute coronary syndrome? In search of a CLEAR answer.

Neutrophil count is a risk factor for myocardial infarction (MI). Colchicine, a drug known as an anti-inflammatory, acts by selectively concentrating on neutrophils and impairing their function. Colchicine has been used successfully in the prevention of vascular events in patients with coronary artery disease (CAD), but recently the largest clinical trial carried out with colchicine in this clinical setting was unexpectedly neutral in the comparison of placebo and colchicine in patients with recent MI. Among the characteristics that distinguish patients with acute coronary syndromes (ACS) from established CAD is the dual antiplatelet therapy (DAPT), often consisting of aspirin and clopidogrel. Clopidogrel significantly reduces neutrophil count and could play a competitive role with colchicine by blunting its clinical effect.