Effect of oral vitamin C on atrial fibrillation development after isolated coronary artery bypass grafting surgery: A prospective randomized clinical trial

Dehghani, Mohammad Reza; Madjidi, Nader; Rahmani, Alireza; Asgari, B; Rezaei, Yousef

doi:10.5603/cj.a2013.0154

Cited by 27 publications

(34 citation statements)

References 29 publications

(32 reference statements)

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“…The proportion of males varied from 58% to 75%. Five trials were carried out in Iran [12,13,15,18,19], two in Egypt [14,16], one in the USA [11], and one in Japan [17]. For detailed descriptions of the trials, see Additional file 1: Table S1.…”

Section: Results Of the Included Trialsmentioning

confidence: 99%

“…Figure 4 indicates that the substantial benefit observed in that trial may be explained by the particularly sick patients with burns requiring very long ventilation, rather than by the very high vitamin C dose. We found that vitamin C shortened the length of ventilation on average by 25% (P = 10 −10 ) when the Tanaka trial was excluded and the analysis was restricted to the five trials with dosage from 1 to 6 g/day for patients ventilated for over 10 h [11,[13][14][15]18]. The Sadeghpour trial [19] is not included in our statistical models because of the high dropout rate, but the results are shown in Fig.…”

Section: Results Of the Included Trialsmentioning

confidence: 99%

“…Finally, we perused the reference lists of the selected trials and relevant reviews, from which we discovered two more trials. We identified nine trials satisfying our selection criteria [11][12][13][14][15][16][17][18][19]. We did not include two further trials that reported "ventilator-free days" since we were unable to convert this to our outcome of interest, "duration of mechanical ventilation" [20,21].…”

Section: Methodsmentioning

confidence: 99%

“…Thus, we The searches were carried out on 13 Nov 2019. The searches identified nine trials that we included in our systematic review analysis [11][12][13][14][15][16][17][18][19] and eight of them were included in our meta-analysis [11][12][13][14][15][16][17][18] calculated that the average dose was 90 g/day in the Tanaka trial. Zabet et al administered 25 mg/kg every 6 h, but the mean weight was not reported [18].…”

Section: Methodsmentioning

confidence: 99%

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Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

2020

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Background: Our recent meta-analysis indicated that vitamin C may shorten the length of ICU stay and the duration of mechanical ventilation. Here we analyze modification of the vitamin C effect on ventilation time, by the control group ventilation time (which we used as a proxy for severity of disease in the patients of each trial). Methods: We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and reference lists of relevant publications. We included controlled trials in which the administration of vitamin C was the only difference between the study groups. We did not limit our search to randomized trials and did not require placebo control. We included all doses and all durations of vitamin C administration. One author extracted study characteristics and outcomes from the trial reports and entered the data in a spreadsheet. Both authors checked the data entered against the original reports. We used meta-regression to examine whether the vitamin C effect on ventilation time depends on the duration of ventilation in the control group.Results: We identified nine potentially eligible trials, eight of which were included in the meta-analysis. We pooled the results of the eight trials, including 685 patients in total, and found that vitamin C shortened the length of mechanical ventilation on average by 14% (P = 0.00001). However, there was significant heterogeneity in the effect of vitamin C between the trials. Heterogeneity was fully explained by the ventilation time in the untreated control group. Vitamin C was most beneficial for patients with the longest ventilation, corresponding to the most severely ill patients. In five trials including 471 patients requiring ventilation for over 10 h, a dosage of 1-6 g/day of vitamin C shortened ventilation time on average by 25% (P < 0.0001). Conclusions: We found strong evidence that vitamin C shortens the duration of mechanical ventilation, but the magnitude of the effect seems to depend on the duration of ventilation in the untreated control group. The level of baseline illness severity should be considered in further research. Different doses should be compared directly in future trials.

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Section: Results Of the Included Trialsmentioning

confidence: 99%

Section: Results Of the Included Trialsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

2020

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“…More recently, Dehghani et al [24] noted a role of oral vitamin C in the prevention of AF after CABG. These data support the inflammatory/ /oxidative stress pathophysiology of postoperative arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors

2013

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Background: Postoperative atrial fibrillation (AF) is a common arrhythmia that occurs after coronary artery bypass grafting (CABG). 3% and 19.3% of CABG and OPCAB patients, respectively (p = 0.3). The peak incidence of arrhythmia was observed between the second and third postoperative day in both CABG and OPCAB patients (36% and 41%, respectively). Patient's age and history of hypertension were significant predictors of postoperative AF (OR 1.38, p = 0.0002; and OR 1.38, p = 0.008, respectively). Patients who developed AF vs. without AF had significantly higher rates of complications such as death (3.1% vs. 1.2%, p = 0.01), reoperation (5.2% vs. 2.8%, p = 0.02), and the need to utilize intra-aortic balloon pump (IABP) (6.8% vs. 3.4%, p = 0.002). Use of IABP and reoperation were significant perioperative predictors of the arrhythmia (OR 2.1, p = 0.003; and OR 1.9, p = 0.02, respectively). AF was also associated with a prolonged stay in an intensive care unit (72.5 ± 78.8 for patients with AF vs. 34.6 ± 25.2 for patients with sinus rhythm, p = 0.000001). Conclusions:In patients undergoing CABG, postoperative AF is a common arrhythmia independent of the type of surgical procedure. (Cardiol J 2016; 23, 5: 518-523)

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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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Effect of oral vitamin C on atrial fibrillation development after isolated coronary artery bypass grafting surgery: A prospective randomized clinical trial

Cited by 27 publications

References 29 publications

Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis

Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors

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

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