Does Tocovid, a Tocotrienol-rich Vitamin E, Mitigate Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting (CABG) Surgery? A Single-Centre Double-blind Randomised Controlled Trial

Abstract

OBJECTIVE: To determine whether tocotrienol-rich Tocovid has any effect in reducing the incidence of postoperative atrial fibrillation (POAF), mortality and morbidity, length of Cardiac Intensive Care Unit (CICU), High Dependency Unit (HDU) and total hospital stay among post coronary artery bypass grafting (CABG) patients; and in improving their quality of life (QOL). METHODS: A single-centre prospective randomised controlled trial was conducted at the National Heart Institute, Kuala Lumpur. The treatment group received Tocovid capsules while the control group received placebo containing palm superolein.  RESULTS: The recruitment of patients started in January 2019 and reached the target population of 250 patients in December 2021. 95.6% of patients completed the study with a 4.4% attrition rate. No statistically significant difference was observed between the age group, gender, race, EuroSCORE II status, body mass index, NYHA class, left or right atrial size, ejection fraction, preoperative medications and premorbid history (except hypercholesterolaemia). There was also no difference in cardiopulmonary bypass time, aortic cross-clamp time, or number of anastomoses. In terms of outcomes, we noted a significant difference in the occurrence of pleural effusion and a longer CICU stay (_p_=0.04) among the placebo groups. The probability of occurrence of POAF was 36.4% with no difference between the two groups and this was reflected in the low blood levels of tocotrienols at day one post-surgery whence the median time for POAF development was 47-hours post-CABG. The quality of life as measured by the 36-Item Short Form Survey (SF-36) and Nottingham Health Profile (NHP) did not show any significant difference except in role physical and role emotional on SF-36 and sleep quality on NHP. CONCLUSION: POAF was not mitigated by Tocovid presumably from low tocotrienol level post-surgery; however, the CICU stay was shortened with reduced pleural effusion, and an improvement in the physical and emotional state with better sleep quality.