Abstract
IntroductionPost-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. Its pathogenesis is initiated by systemic inflammation and oxidative stress. It is hypothesised that a potent antioxidant and anti-inflammatory agent such as tocotrienol, an isomer of Vitamin E, could reduce or prevent POAF.AimsThe aim of this study is to determine whether a potent antioxidative and anti-inflammatory agent, Tocovid, a tocotrienol-rich capsule, could reduce the incidence of POAF and affect the mortality and morbidity as well as the duration of ICU, HDU and hospital stay.MethodsThis study was planned as a prospective, randomised, controlled trial with parallel groups. The control group received placebo containing palm superolein while the treatment group received Tocovid capsules. We investigated the incidence of POAF, the length of hospital stay after surgery and the health-related quality of life.ResultsRecruitment commenced in January 2019 but the preliminary results were unblinded as the study is still ongoing. Two-hundred and two patients have been recruited out of a target sample size of 250 as of January 2021. About 75% have completed the study and 6.4% were either lost during follow-up or withdrew; 4% of participants died. The mean age group was 61.44 ± 7.30 years with no statistical difference between the groups, with males having a preponderance for AF. The incidence of POAF was 24.36% and the mean time for developing POAF was 55.38 ± 29.9 h post-CABG. Obesity was not a predictive factor. No statistically significant difference was observed when comparing left atrial size, NYHA class, ejection fraction and the premorbid history. The mean cross-clamp time was 71 ± 34 min and the mean bypass time was 95 ± 46 min, with no difference between groups. There was a threefold increase in death among patients with POAF (p = 0.008) and an increase in the duration of ICU stay (p = 0.01), the total duration of hospital stay (p = 0.04) and reintubation (p = 0.045).ConclusionA relatively low incidence rate of POAF was noted although the study is still ongoing. It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF.Clinical Registration Number: US National Library of Medicine. Clinical Trials - NCT03807037. Registered on 16th January 2019. Link: https://clinicaltrials.gov/ct2/show/NCT03807037
Highlights
Post-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality
It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF
In our own retrospective study [2] conducted on post-coronary artery bypass grafting (CABG) patients at the National Heart Institute (IJN), Kuala Lumpur, it was demonstrated that patients who developed POAF had a prolonged Intensive Care Unit (ICU) stay, High Dependency Unit (HDU) stay and total hospital stay, with a concomitant consumption of healthcare resources
Summary
Post-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. A recent meta-analysis on the known anti-oxidant Vitamin C [13] has shown promising results in reducing POAF along with a shorter ICU and hospital stay. This has encouraged us to use a more potent anti-oxidant and anti-inflammatory agent, tocotrienol [14, 15], which is an isomer of Vitamin E as a compound that could potentially reduce the incidence of POAF and shorten the ICU and hospital stay just like its related, Vitamin C, in our current study
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have