Perioperative supplementation with ascorbic acid does not prevent atrial fibrillation in coronary artery bypass graft patients

Bjordahl, Paul; Helmer, Stephen D.; Gosnell, Dawn; Wemmer, Gail E.; O'Hara, Walter W.; Milfeld, Douglas J.

doi:10.1016/j.amjsurg.2012.03.012

Cited by 48 publications

(44 citation statements)

References 13 publications

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“…The administration of oral vitamin C peri-operatively to patients undergoing CABG does not seem to be associated with reduced incidence of POAF (Bjordahl, et al, 2012). However when used in combination with -blockers, it was noted that it can favourably influence the A C C E P T E D M A N U S C R I P T…”

Section: Vitamins C and Ementioning

confidence: 97%

Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery

Zakkar

Ascione

James

et al. 2015

Pharmacology & Therapeutics

184

129

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Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions.

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Section: Vitamins C and Ementioning

confidence: 97%

Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery

Zakkar

Ascione

James

et al. 2015

Pharmacology & Therapeutics

184

129

View full text Add to dashboard Cite

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“…Two trials were conducted in patients scheduled for cardiac surgery. Bjordahl and coworkers 98 studied 185 patients. Half of the patients received 2 g ascorbic acid by mouth the evening before surgery and 2 g/d by mouth or enteral tube for 5 days, while the others received standard care.…”

Section: Vitamin Cmentioning

confidence: 99%

Antioxidant Vitamins and Trace Elements in Critical Illness

2016

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This comprehensive narrative review summarizes relevant antioxidant mechanisms, the antioxidant status, and effects of supplementation in critically ill patients for the most studied antioxidant vitamins A, C, and E and the enzyme cofactor trace elements selenium and zinc. Over the past 15 years, oxidative stress-mediated cell damage has been recognized to be fundamental to the pathophysiology of various critical illnesses such as acute respiratory distress syndrome, ischemia-reperfusion injury, and multiorgan dysfunction in sepsis. Related to these conditions, low plasma levels of antioxidant enzymes, vitamins, and trace elements have been frequently reported, and thus supplementation seems logical. However, low antioxidant plasma levels per se may not indicate low total body stores as critical illness may induce redistribution of antioxidants. Furthermore, low antioxidant levels may even be beneficial as pro-oxidants are essential in bacterial killing. The reviewed studies in critically ill patients show conflicting results. This may be due to different patient populations, study designs, timing, dosing regimens, and duration of the intervention and outcome measures evaluated. Therefore, at present, it remains unclear whether supplementation of antioxidant micronutrients has any clinical benefit in critically ill patients as some studies show clear benefits, whereas others demonstrate neutral outcomes and even harm. Combination therapy of antioxidants seems logical as they work in synergy and function as elements of the human antioxidant network. Further research should focus on defining the normal antioxidant status for critically ill patients and to study optimal supplement combinations either by nutrition enrichment or by enteral or parenteral pharmacological interventions.

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“…Another study reported on the duration of postoperative vasopressor treatment and observed no difference between the groups (1.1 ± 1.2 days [vitamin C] vs, 1.1 ± 1.3 days [control], p = 0.940) [26]. Two studies reported on use of inotropes during the first 24 h after surgery, which was significantly lower in the control group (56% vitamin C group vs. 36% in the control group, p = 0.045) in Alshafey´s RCT [20] and similar (20% in the vitamin C group vs. 22% in the control group, p = 0.81) in the RCT by Eslami et al [31].…”

Section: Organ Functionmentioning

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 supplementation with ascorbic acid does not prevent atrial fibrillation in coronary artery bypass graft patients

Cited by 48 publications

References 13 publications

Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery

Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery

Antioxidant Vitamins and Trace Elements in Critical Illness

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

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