Meta-analysis of ascorbic acid for prevention of postoperative atrial fibrillation after cardiac surgery

Baker, William L.; Coleman, Craig I.

doi:10.2146/ajhp160066

Cited by 23 publications

(27 citation statements)

References 43 publications

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“…Several meta‐analyses on this issue also confirmed the preventive role of vitamin C on POAF (see Supporting Information, Table S4, in the online version of this article). However, subgroup or sensitivity analyses were not performed in most of them, and cohort studies were included in the study by Polymeropoulos et al Non‐RCTs were treated as RCTs and involved for meta‐analysis in 3 meta‐analyses, and study of noncardiac surgery was analyzed in the study by Hemilä et al…”

Section: Discussionsupporting

confidence: 56%

“…Numerous pharmacologic interventions attempt to reduce the incidence of POAF; all of them have limitations and adverse effects . It is reported that vitamin C is a promising and cost‐effective prophylactic therapy for POAF, and several meta‐analyses of randomized controlled trials (RCTs) of vitamin C for arrhythmia prophylaxis have been published . Though they all demonstrated that vitamin C could reduce the incidence of POAF, the study design and quality of included studies are poor.…”

Section: Introductionmentioning

confidence: 99%

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Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Shi

Chen

et al. 2018

Clinical Cardiology

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We undertook a systematic review and meta-analysis to evaluate the effect of vitamin C supplementation (vitamin C solely or as adjunct to other therapy) on prevention of postoperative atrial fibrillation (POAF) in patients after cardiac surgery. PubMed, Embase, Web of Science, and Cochrane Library were systematically searched to identify randomized controlled trials assessing the effect of vitamin C supplementation in adult patients undergoing cardiac surgery, and the meta-analysis was performed with a random-effects model. Thirteen trials involving 1956 patients were included. Pooling estimate showed a significantly reduced incidence of POAF (relative risk [RR]: 0.68, 95% confidence interval [CI]: 0.54 to 0.87, P = 0.002) both in vitamin C alone (RR: 0.75, 95% CI: 0.63 to 0.90, P = 0.002) and as an adjunct to other therapy (RR: 0.32, 95% CI: 0.20 to 0.53, P < 0.001). The results remain stable and robust in subgroup and sensitivity analyses, and trial sequential analysis also confirmed that the evidence was sufficient and conclusive. Additionally, vitamin C could significantly decrease intensive care unit length of stay (weighted mean difference: -0.24 days, 95% CI: -0.45 to -0.03, P = 0.023), hospital length of stay (weighted mean difference: -0.95 days, 95% CI: -1.64 to -0.26, P = 0.007), and risk of adverse events (RR: 0.45, 95% CI: 0.21 to 0.96, P = 0.039). Use of vitamin C alone and as adjunct to other therapy can prevent POAF in patients undergoing cardiac surgery and should be recommended for patients receiving cardiac surgery for prevention of POAF.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Shi

Chen

et al. 2018

Clinical Cardiology

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“…A reduced ICU-LOS was also observed by three meta-analyses focusing exclusively on perioperative vitamin C administration [11,13,15] and one meta-analysis investigating the antioxidant effects of vitamins by Geng et al [38]. Four meta-analyses also found significantly shorter hospital-LOS associated with vitamin C [11,15,39,40]. However, Hu et al performed a meta-analysis where vitamin C administration was not associated with reductions in either ICU- or hospital-LOS [14].…”

Section: Discussionmentioning

confidence: 81%

“…Surprisingly, most of them have focused predominantly on the occurrence of atrial fibrillation [11,12,13,14,15]. However, despite the clinical significance of postoperative arrhythmia, the effects of vitamin C on the patient’s organ functions and long-term outcomes remain largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ-protective micronutrient. Past clinical trials and meta-analyses have focused predominantly on occurrence of postoperative atrial fibrillation. Therefore, we investigated the influence of perioperative vitamin C administration on clinically relevant parameters closer related to the patient’s recovery, especially organ function, and overall outcomes after cardiac surgery. Methods: Randomized controlled trials (RCTs) comparing perioperative vitamin C administration versus placebo or standard of care in adult patients undergoing cardiac surgery were identified through systematic searches in Pubmed, EMBASE, and CENTRAL on 23 November 2018. Published and unpublished data were included. Assessed outcomes include organ function after cardiac surgery, adverse events, in-hospital mortality, intensive care unit, and hospital length-of-stay. Data was pooled only when appropriate. Results: A total of 19 RCTs with 2008 patients were included in this meta-analysis. Vitamin C significantly decreased the incidence of atrial fibrillation (p = 0.008), ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and hospital length-of-stay (p < 0.0001). However, on average, vitamin C had no significant effects on in-hospital mortality (p = 0.76), or on the incidence of stroke (p = 0.82). High statistical heterogeneity was observed in most analyses. Conclusions: Vitamin C impacts clinically and economically important outcomes, such as ICU and hospital length-of-stay, duration of mechanical ventilation and lowers the incidence of atrial fibrillation. Due to missing reports on organ dysfunction, this meta-analysis cannot answer the question, if vitamin C can improve single- or multiorgan function after cardiac surgery.

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“…Perioperative vitamin C administration has also been shown to prevent post-operative atrial fibrillation in the majority of the studies[ 54 - 59 ]. Its effects appear to result in reductions in the duration of hospital and intensive care unit patient stay following cardiac surgery[ 54 - 57 ].…”

Section: Vitamin C In Cardiovascular Patientsmentioning

confidence: 99%

Vitamin C in the critically ill - indications and controversies

Nabzdyk

Bittner

2018

WJCCM

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Ascorbic acid (vitamin C) elicits pleiotropic effects in the body. Among its functions, it serves as a potent anti-oxidant, a co-factor in collagen and catecholamine synthesis, and a modulator of immune cell biology. Furthermore, an increasing body of evidence suggests that high-dose vitamin C administration improves hemodynamics, end-organ function, and may improve survival in critically ill patients. This article reviews studies that evaluate vitamin C in pre-clinical models and clinical trials with respect to its therapeutic potential.

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Meta-analysis of ascorbic acid for prevention of postoperative atrial fibrillation after cardiac surgery

Abstract: A meta-analysis revealed that, compared with use of a placebo or a nonplacebo control, perioperative administration of ascorbic acid to patients undergoing cardiac surgery was associated with a reduced frequency of POAF and a shorter ICU LOS and total hospital LOS.

Cited by 23 publications

References 43 publications

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

Vitamin C in the critically ill - indications and controversies

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