N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial

© The author(s). Regular blood transfusions in transfusion-dependent thalassemia (TDT) patients can lead to iron overload, causing oxidative stress and sympathovagal imbalance, resulting in increased cardiac complications. We hypothesized that administrating of N-acetylcysteine (NAC) prevents seriou...

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Main Authors: Sintip Pattanakuhar, Arintaya Phrommintikul, Adisak Tantiworawit, Somdet Srichairattanakool, Siriporn C. Chattipakorn
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Published: 2020
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/70909
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spelling th-cmuir.6653943832-709092020-10-14T08:44:29Z N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial Sintip Pattanakuhar Arintaya Phrommintikul Adisak Tantiworawit Somdet Srichairattanakool Siriporn C. Chattipakorn Medicine © The author(s). Regular blood transfusions in transfusion-dependent thalassemia (TDT) patients can lead to iron overload, causing oxidative stress and sympathovagal imbalance, resulting in increased cardiac complications. We hypothesized that administrating of N-acetylcysteine (NAC) prevents serious adverse events including cardiac complications in TDT patients by reducing systemic oxidative stress and balancing cardiac sympathovagal control. This study was double-blind, randomized control trial, investigating in 59 Thai TDT patients. After randomization, the participants were divided into two groups. The control group received standard care of TDT patient plus placebo, whereas the intervention group received 600 mg of NAC orally for six months. Serum 8-isoprostane, TNF-alpha, IL-10, 24-hour ECG monitoring, echocardiograms and the incidence of thalassemia-related complications were collected. At baseline, no significant difference in any parameters between the control and the intervention groups. At the end of intervention, the incidence of serious adverse events (i.e. infection, worsening thalassemia) was significantly higher in the control group when compared with the intervention group (24.1% vs. 3.3%, p=0.019) (Chi-square test; absolute risk reduction=20.8%, number needed to treat=4.8). The control group also had significantly lower time-dependent HRV parameters, compared with the intervention group (p=0.025 and 0.030, independent t-test). Treatment with NAC restored HRV and reduced serious adverse event in TDT patients, however, no difference in cardiac complications could be demonstrated. NAC could prevent serious adverse events in TDT patients. The proposed mechanism might be the balancing of sympathovagal control. 2020-10-14T08:44:29Z 2020-10-14T08:44:29Z 2020-01-01 Journal 14491907 2-s2.0-85086686557 10.7150/ijms.45795 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85086686557&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/70909
institution Chiang Mai University
building Chiang Mai University Library
continent Asia
country Thailand
Thailand
content_provider Chiang Mai University Library
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Sintip Pattanakuhar
Arintaya Phrommintikul
Adisak Tantiworawit
Somdet Srichairattanakool
Siriporn C. Chattipakorn
N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial
description © The author(s). Regular blood transfusions in transfusion-dependent thalassemia (TDT) patients can lead to iron overload, causing oxidative stress and sympathovagal imbalance, resulting in increased cardiac complications. We hypothesized that administrating of N-acetylcysteine (NAC) prevents serious adverse events including cardiac complications in TDT patients by reducing systemic oxidative stress and balancing cardiac sympathovagal control. This study was double-blind, randomized control trial, investigating in 59 Thai TDT patients. After randomization, the participants were divided into two groups. The control group received standard care of TDT patient plus placebo, whereas the intervention group received 600 mg of NAC orally for six months. Serum 8-isoprostane, TNF-alpha, IL-10, 24-hour ECG monitoring, echocardiograms and the incidence of thalassemia-related complications were collected. At baseline, no significant difference in any parameters between the control and the intervention groups. At the end of intervention, the incidence of serious adverse events (i.e. infection, worsening thalassemia) was significantly higher in the control group when compared with the intervention group (24.1% vs. 3.3%, p=0.019) (Chi-square test; absolute risk reduction=20.8%, number needed to treat=4.8). The control group also had significantly lower time-dependent HRV parameters, compared with the intervention group (p=0.025 and 0.030, independent t-test). Treatment with NAC restored HRV and reduced serious adverse event in TDT patients, however, no difference in cardiac complications could be demonstrated. NAC could prevent serious adverse events in TDT patients. The proposed mechanism might be the balancing of sympathovagal control.
format Journal
author Sintip Pattanakuhar
Arintaya Phrommintikul
Adisak Tantiworawit
Somdet Srichairattanakool
Siriporn C. Chattipakorn
author_facet Sintip Pattanakuhar
Arintaya Phrommintikul
Adisak Tantiworawit
Somdet Srichairattanakool
Siriporn C. Chattipakorn
author_sort Sintip Pattanakuhar
title N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial
title_short N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial
title_full N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial
title_fullStr N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial
title_full_unstemmed N-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: A double-blind single center randomized controlled trial
title_sort n-acetylcysteine restored heart rate variability and prevented serious adverse events in transfusion-dependent thalassemia patients: a double-blind single center randomized controlled trial
publishDate 2020
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85086686557&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/70909
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