Databases like PubMed, Embase, and Cochrane were searched till September 2024. Risk ratios (RR) with 95% confidence intervals (CI) were pooled for the dichotomous outcomes under the random effects model on Review Manager 5.4.1. The primary outcome was ischemic stroke recurrence. Secondary outcomes were overall stroke risk (ischemic and non-ischemic), serious adverse events, all-cause mortality, cardiovascular mortality, and gastrointestinal (GI) hemorrhage. The quality assessment was done by the Newcastle Ottawa Scale and Cochrane RoB 2.0 tool. A leave-one-out sensitivity analysis was performed to assess the cause of heterogeneity.

A total of three studies, involving 6,657 patients in the colchicine group and 361,240 patients in the placebo group, were included. The pooled analysis showed that colchicine resulted in a non-significant decrease in ischemic stroke recurrence (RR=0.93; 95%CI:[0.84-1.04]; p=0.22; I²=3%), overall stroke risk (RR=0.90; 95%CI:[0.74-1.09]; p=0.29; I²=45%), serious adverse events (RR=0.99; 95%CI:[0.94-1.03]; p=0.59; I²=0%) compared to the placebo. The two groups were comparable in terms of all-cause mortality (RR=1.10; 95%CI:[0.78-1.57]; p=0.58; I²=67%), cardiovascular mortality (RR=1.22; 95%CI:[0.43-3.44]; p=0.71; I²=90%), and the risk of GI hemorrhage (RR=0.76; 95%CI:[0.44-1.33]; p=0.34; I²=0%).