Influence of intravenous vitamin E supplementation in cardiac surgery on oxidative stress: a double-blinded, randomized, controlled study

Lassnigg, Andrea; Punz, A.; Barker, Renate; Keznickl, P.; Manhart, N.; Roth, Erich; Hiesmayr, Michael

doi:10.1093/bja/aeg042

Cited by 92 publications

(66 citation statements)

References 27 publications

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“…Plasma MDA levels are one of the most commonly used markers of lipid peroxidation. Increased venous concentration of MDA has been found in patients subjected to cardiac surgery [20][21][22]. However, an MDA concentration in systemic blood may reflect changes unrelated to the cardiac oxidative stress (prostanoid synthesis) activity of aldehyde-dehydrogenase and aldose reductase [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Calcium dobesilate may improve hemorheology in patients undergoing coronary artery bypass grafting

Beşirli

Aydemir

Arslan

et al. 2012

Rev Bras Cir Cardiovasc

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Dobesilato de cálcio pode melhorar hemorreologia em pacientes submetidos à cirurgia de revascularização miocárdicaCalcium dobesilate may improve hemorheology in patients undergoing coronary artery bypass grafting Abstract Background: Calcium dobesilate is an angioprotective agent that has positive effects on hemorheological parameters. It is an antioxidant that increases endothelialderived vasodilator substance secretion, there are none that analyze its effects during the postoperative period of patients undergoing myocardial revascularization.Objective: We aimed to determine the effects of calcium dobesilate on hemorheological parameters, such as reduced glutathione and malondialdehyde in patients with ischemic heart disease undergoing myocardial revascularization in the postoperative period.Methods: One hundred and thirty-four patients operated for coronary heart disease were included in this study. Hemorheological, oxidant and antioxidant parameters were measured two days after surgery and after a period of treatment with calcium dobesilate. Then, 500 mg of calcium dobesilate was given twice a day to one group of 68 patients for three months. The control group was composed of 66 patients who did not receive this medication.Results: The increase in the erythrocyte deformability index was found to be significant compared with both the pretreatment values and with the 1 st and 2 nd values of the control group after calcium dobesilate administration, whereas there were no significant changes in blood viscosity, glutathione (GSH) or malondialdehyde (MDA) values after the calcium dobesilate administration. The same improvement in the CCS class was observed in patients regardless of they received the calcium dobesilate treatment.Conclusion: In the present investigation, the same improvement in the CCS class was observed in patients regardless of they received the calcium dobesilate treatment. Improvements with calcium dobesilate were statistically significant only in the increase in erythrocyte flexibility.Descriptors: Coronary artery disease. Atherosclerosis. Coronary artery bypass. ResumoAntecedentes: O dobesilato de cálcio é um agente angioprotetor que tem efeitos positivos sobre os parâmetros hemorreológicos. É um antioxidante que aumenta a secreção endotelial derivada da substância vasodilatadora, não há nada que analisar os seus efeitos durante o período pós-operatório de pacientes submetidos a revascularização do miocárdio.Objetivo: Nosso objetivo foi determinar os efeitos de dobesilato de cálcio sobre os parâmetros hemorreológicos, tais como glutationa reduzida e malondialdeído em pacientes com doença cardíaca isquêmica submetidos a revascularização do miocárdio no pós-operatório. RBCCV 44205-1379

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Section: Discussionmentioning

confidence: 99%

Calcium dobesilate may improve hemorheology in patients undergoing coronary artery bypass grafting

Beşirli

Aydemir

Arslan

et al. 2012

Rev Bras Cir Cardiovasc

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“…Similar to the Haase study, Lassnigg et al [17] performed a randomized double-blind placebo-controlled trial investigating the role of intravenous vitamin E supplementation in reducing ischemia-reperfusion injury after elective cardiac surgery. While this study was designed to detect differences in a variety of biochemical markers of oxidative stress (malondialdehyde, creatine kinase, interleukin (IL) 6 in the presence of absence of 4 perioperative doses of 270 mg of vitamin E, it did not demonstrate any difference in these levels, nor did it demonstrate any difference in the rates of AKI [17].…”

Section: Oxidant Mechanismmentioning

confidence: 99%

“…While this study was designed to detect differences in a variety of biochemical markers of oxidative stress (malondialdehyde, creatine kinase, interleukin (IL) 6 in the presence of absence of 4 perioperative doses of 270 mg of vitamin E, it did not demonstrate any difference in these levels, nor did it demonstrate any difference in the rates of AKI [17]. Finally, mannitol has been investigated as a therapeutic option to decrease the ROM load following adult cardiac surgery.…”

Section: Oxidant Mechanismmentioning

confidence: 99%

Antioxidants

Koyner

Ali

Murray

2008

Nephron Exp Nephrol

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Over the past several years, advances in our understanding of the pathogenesis of acute kidney injury (AKI) have demonstrated the role of oxidant stress and reactive oxygen metabolites (ROM) in the development of AKI in a variety of clinical settings. This review serves to define the pathways that lead to the generation of ROM following a variety of insults, as well as to review the current literature concerning the role of antioxidant therapy in the prevention and treatment of AKI in several clinical settings. Investigators have explored the potential therapeutic role of anti-oxidants in both experimental animal models and human studies of AKI in several clinical settings, including cardiac and aortic occlusive surgeries, sepsis, drug nephrotoxicity (cisplatin and gentamicin), as well as rhabdomyolysis. While the experimental animal studies have generally been more successful, taken together this literature supports the hypothesis that oxidant stress-induced production of ROM plays a major role in the pathogenesis of many forms of AKI, and continues to suggest the potential utility of antioxidant therapy in human AKI. Ongoing trials in concert with improved diagnostic techniques will hopefully lead to improved outcomes in the setting of AKI through the prophylactic or early therapeutic use of antioxidant therapy.

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“…When used in isolation the results indicate that vitamin E has no protective effect, 95 while studies using combination antioxidant therapy have shown reductions in POAF in the treatment groups. 96,97 Such studies suggest a synergistic effect, which needs to be confirmed by more rigorous studies.…”

Section: Vitamin Ementioning

confidence: 97%

“…94 Although vitamin E levels are reduced during cardiac surgery and can be normalised with supplementation, another study showed that there was no reduction in lipid peroxidation after supplementation. 95 Studies that have investigated the ability of…”

Section: Vitamin Ementioning

confidence: 99%

Selenium and oxidative stress modulation during extracorporeal circulation

McDonald¹

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Oxidative stress occurs when there is an imbalance between reactive oxygen and nitrogen species (RNOS) and the antioxidant system. In cardiac surgery patients and the critically ill there is an association between oxidative stress and morbidity and mortality.Extracorporeal circulation (ECC) encompasses cardiopulmonary bypass (CPB) which is used for cardiac surgery; extracorporeal membrane oxygenation (ECMO) which is used for cardio-respiratory support in the critically ill and haemodialysis which is used in patients with intermittent or end-stage renal failure.During ECC, the patient's total blood volume is in direct contact with an artificial surface for extended periods. In addition, there is often pre-existing inflammation, surgical trauma and/or ischemia-reperfusion (I-R) injury, all of which are major activators for the increased production of RNOS. Concurrent decreases in the level of essential antioxidants and trace elements (such as selenium, zinc and copper) occur, which upset redox balance in favour of oxidative stress. The trace element selenium is required for the normal function of the antioxidant enzyme glutathione peroxidase (GPx). Despite in vitro and biochemical data suggesting that reinforcement of antioxidant activity by selenium supplementation might reduce excessive oxidative stress damage, there is conflicting evidence in clinical studies.The reason for failure of antioxidant supplementation in the clinical setting is currently unclear.We postulated that the ECC and its associated interventions such as transfusion, might have a larger impact on trace element loss, antioxidant function and the oxidative stress response than previously recognised. This led to the following questions:  What is the selenium level in healthy Queensland residents, and is this level similar to that reported in other parts of the world? Does a patient's pre-CPB or pre-ECMO circulating selenium level influence their outcome? Does the ECC independently alter circulating selenium levels and the oxidative stress response? Do other interventions during ECC, such as transfusion, alter circulating selenium and oxidative stress levels?iii This thesis focussed on oxidative stress and the trace element selenium, because oxidative stress is associated with poorer outcomes in cardiac and critically ill patients, and decreased selenium is independently associated with poorer outcomes. To answer the research questions outlined above, a series of experiments were designed and conducted, and they generated the following new information.The average selenium level in a Queensland blood donor population was defined at 1.09 µmol/L (Chapter 3). In addition 88.5% of participants had a selenium level lower than the critical level required for maximal glutathione peroxidase activity, which has previously been determined to be between 1.14 -1.27 µmol/L. Furthermore, this study generated novel information that packed red blood cells and buffy coat pooled platelets have very low levels of selenium (≤ 0.3 µmol/L).The effect of car...

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Influence of intravenous vitamin E supplementation in cardiac surgery on oxidative stress: a double-blinded, randomized, controlled study

Abstract: Normalization of plasma vitamin E concentrations with parenteral vitamin E emulsion does not affect biochemical markers of myocardial injury and does not affect clinical outcome after cardiac surgery.

Cited by 92 publications

References 27 publications

Calcium dobesilate may improve hemorheology in patients undergoing coronary artery bypass grafting

Calcium dobesilate may improve hemorheology in patients undergoing coronary artery bypass grafting

Antioxidants

Selenium and oxidative stress modulation during extracorporeal circulation

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