Original articleN-acetylcysteine in Cardiac Surgery: Do the Benefits Outweigh the Risks? A Meta-Analytic Reappraisal
Section snippets
Methods
This meta-analysis of randomized trials was performed in accordance with Quality of Reporting of Meta-analyses and Recommendations and according to a protocol that prespecified outcomes, search strategies, inclusion criteria, and statistical analyses.21 A comprehensive search was undertaken to identify all published or unpublished randomized trials of NAC versus placebo during cardiac surgery in any language. MEDLINE, Cochrane CENTRAL, EMBASE, Current Contents, DARE (Database of Abstracts of
Results
Figure 1 outlines the search results. A total of 98 citations were screened. After reviewing the abstracts, 22 trials were retrieved for a full-text review. Of these, 7 trials were excluded because they did not meet the preset inclusion criteria. Therefore, a total of 1,407 patients in 15 original trials provided data for this meta-analysis (Table 1).3, 5, 6, 7, 8, 9, 15, 17, 18, 19, 20, 27, 28, 29, 30 Twelve studies used intravenous NAC during the perioperative period, 2 studies used an oral
Discussion
This meta-analysis of randomized trials assessed whether NAC, an inexpensive and well-tolerated medication with antioxidant and anti-inflammatory properties, reduces mortality, morbidity, and resource utilization in patients undergoing cardiac surgery. The present authors found that the perioperative use of NAC in patients undergoing cardiac surgery is not effective for the prevention of ARF, need for renal replacement therapy, new AF, mortality, or other adverse clinical outcomes.
NAC may
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