Effect of long-term remote ischaemic conditioning on platelet function and fibrinolysis in patients with chronic ischaemic heart failure

Circulating mediators of remote ischemic preconditioning: search for the missing link between non-lethal ischemia and cardioprotection

“…In a non-invasive approach, RIPC has the capacity to protect the organ or tissue whether applied prior to I/R (RIPC), after ischemia but prior to reperfusion (PerC) [15] or during reperfusion (remote ischemic postconditioning, RIPost) [16]. Pryds and colleagues demonstrated the long term effect of RIPC on heart failure patients and reported that though RIPC does not improve left ventricular ejection fraction (LVEF) but reduces blood pressure and NT-proBNP in patients with compensated chronic ischemic heart failure [17] and may reduce the risk of thrombosis by stimulating fibrinolysis [18]. Table 1 summarizes the key clinical trials on the effect of RIPC prior to coronary artery bypass graft (CABG) and PCI.…”

Local and systemic coagulation marker response to musculocutaneous flap ischemia–reperfusion injury and remote ischemic conditioning: An experimental study in a porcine model

“…The thrombin generation assay failed in 13 plasma samples, which could be explained by the use of a human assay and the high tissue factor concentration. The present study primarily measured markers of secondary hemostasis, while RIC reduced platelet activity (Lanza et al, ; Pedersen et al, ; Ropcke et al, ) and increased fibrinolysis (Meng et al, ; Pryds et al, ) in previous animal and clinical studies on nonflap tissues. Finally, the effects of RIC in the present study could be underestimated by the small sample size of eight animals in each group.…”

Ischemic Conditioning as a Hemostatic Intervention in Surgery and Cardiac Procedures: A Systematic Review

“…82,83 No consistent effect on secondary hemostasis has been found in healthy subjects and patients as well as in patients undergoing surgery. [21][22][23]26,54,78,79 The intervention increased fibrinolysis in patients with cerebrovascular disease and chronic ischemic heart failure, 25,26 but not in healthy males, 23,24 and the effects on fibrinolysis have not Liver resection (n ¼ 7): no effect on secondary hemostasis 10,[31][32][33][34]36,37 Cardiac procedures (n ¼ 2): reduced platelet activation 41,44 PCI (n ¼ 1): no effect on MI 40 Liver resection (n ¼ 9): no effect in eight studies 10,[30][31][32][33][34]36,37 Reduced intraop. bleeding in one study 35 Cardiac surgery (n ¼ 2): no effect 42,43 Remote ischemic conditioning Liver transplantation (n ¼ 1): no effect on secondary hemostasis 54 Aneurysmal subarachnoid hemorrhage (n ¼ 1): increased PT/INR but not PTT 78 Cardiac procedures (n ¼ 2): reduced platelet activation 82,83 Vascular surgery (n ¼ 8): no effect in seven studies [45][46][47][48]…”

“…89 Remote ischemic conditioning influenced laboratory parameters of hemostasis in study participants with no ischemic event close to the intervention. 21,22,25,26,78,79 Hence, the intervention could modulate hemostasis by directly affecting platelets or the fibrinolytic system without a preceding ischemic event.…”

“…21,22 Neither secondary hemostasis nor fibrinolysis was influenced by remote ischemic conditioning in a study on healthy men with no ischemic event, 23 and remote ischemic conditioning did not attenuate the fibrinolytic dysfunction following experimentally induced extremity ischemia-reperfusion injury in healthy males. 24 Longterm administration of remote ischemic conditioning has been shown to increase fibrinolysis in patients with chronic ischemic heart failure, 25 as well as increase fibrinolysis and reduce platelet aggregation in patients with cerebrovascular disease. 26 Hence, several previous studies indicate a direct impact of remote ischemic conditioning on laboratory parameters of hemostasis, particularly a reduction in platelet activity and increased fibrinolysis.…”