Vitamin C for the Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

Polymeropoulos, Evangelos; Bagos, Pantelis G.; Papadimitriou, Maria; Rizos, Ioannis; Patsouris, Efstratios; Toumpoulis, Ioannis K.

doi:10.15171/apb.2016.033

Cited by 25 publications

(32 citation statements)

References 55 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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“…Regarding atrial fibrillation, our results confirm the results of other meta-analyses [12,13,14,15], who all found a significant beneficial effect of vitamin C. None of the other meta-analyses assessed organ dysfunctions other than atrial fibrillation, but Shi et al found significantly fewer adverse events in patients receiving vitamin C [15]. …”

Section: Discussionsupporting

confidence: 88%

“…Full text not accessible, attempts to contact author unsuccessful.14Liu 2010 [50]Letter to the editor15Moludi 2016 [51]Paper and abstract within the university´s journal, abstract identical to included publiction by Sadeghpour et al [19]16Oktar 2001 [52]No randomization17Oudemans-van Straten [7]Review18Polymeropoulos 2016 [12]Meta-analysis19Rasoli 2011 [53]Review20Rodrigo 2008 [54]Review21Rodrigo 2009 [55]Review22Rebrova [56]No randomization23Sisto 1995 [57]Inappropriate comedication (allopurinol)24Samadikah 2014 [58]Inappropriate comedication (statin)25Shi 2018 [15]Meta-analysis26NCT00519337Registered trial on , no results posted or found28NCT01167569<...>…”

Section: Appendix B1 Selection Biasmentioning

confidence: 99%

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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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Role of inflammation in atrial fibrillation: A comprehensive review of current knowledge

Nso

Bookani

Metzl

et al. 2020

Journal of Arrhythmia

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Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia in adults. It is more common in the elderly, affecting about 1% of people under 65 years old but 5% of people over 65. 1 AF is associated with significant morbidity and mortality and has adverse effects on overall quality of life. Even patients with short-term (≤7 days) AF have an increased risk of stroke. 2 Furthermore, given the aging of our society, the economic burden of AF is enormous. Current management options are suboptimal. Outcomes of rhythm and rate control efforts have shown the limited efficacy and high side effects of both methods. 3 Therefore, there is a significant need for alternative, safe, and effective methods of treatment. This strong need has prompted a fundamental re-evaluation of the pathophysiology of AF with the goal of finding new approaches to treatment. Inflammatory processes are among the major focuses of current medical research and there are increasing evidences that inflammation may play a major role in cardiovascular diseases including

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Vitamin C for the Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

Cited by 25 publications

References 55 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

Role of inflammation in atrial fibrillation: A comprehensive review of current knowledge

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