Colchicine in the secondary prevention of stroke and major cardiovascular events in patients with stroke or at high risk of it: Systematic review and meta-analysis.

BACKGROUND AND AIM: To assess the efficacy and optimal dose of colchicine in preventing stroke and other major cardiovascular events in patients with stroke or at high risk of stroke. We specified the high-risk group to have thrombosis, cardioembolic due to Atrial fibrillation, and non-cardioembolic stroke, or TIA.

METHODS

A meta-analysis following the PRISMA 2020 guidelines, and searching PubMed, Scopus, Web of Science, and the Cochrane Library. The primary endpoints were stroke and major cardiovascular events. Subgroup analysis was conducted according to the primary disease, colchicine dose, and duration of the intervention. A meta-regression was performed to assess the effect of mean age, proportion of males, and diabetic patients on the effect size of the outcomes.

RESULTS

We searched until March 29, 2025, and identified 22 studies, including 32970 patients. Their diseases were acute and chronic coronary syndrome, atrial fibrillation, and non-cardioembolic stroke. Colchicine was better than placebo in stroke prevention with no statistical significance. It was effective in preventing myocardial infarction in patients with chronic coronary syndrome with no effect on it in patients with acute coronary syndrome. One model meta-regression on stroke, myocardial infarction, MACE, and death revealed no effect on the effect size of these outcomes.

CONCLUSION

Colchicine 0.5 mg daily is a good preventive therapy for patients with stroke or at risk for it. It has a statistically significant benefit for preventing myocardial infarction in patients with chronic coronary syndromes. Additional randomized trials are needed to assess the efficacy of colchicine in patients with chronic coronary syndrome.