Effects of Remote Ischemic Preconditioning on the Coagulation Profile of Patients With Aneurysmal Subarachnoid Hemorrhage

Abstract

RIPC by limb ischemia appears to prolong the PT and INR in human subjects with SAH after at least 4 sessions, correlating with the number of sessions. However, values remained within normal range and there were no hemorrhagic complications.

Remote Limb Ischemic Conditioning at Two Cuff Inflation Pressures Yields Learning Enhancements in Healthy Adults

“…Our findings that RLIC did not change the hemostasis metrics PT, INR, nor the concentrations of circulating VEGF, TNF-α, and IL-6, add to a body of literature that is conflicted regarding blood biomarkers that are responsive to ischemic limb conditioning. With respect to measures of homeostasis, ischemic conditioning can influence the expression of genes involved in hemostasis and fibrinolysis time in animals (He, Karabiyikoglu, Hua, Keep, & Xi, 2012; Stenzel-Poore et al, 2003; Warzecha et al, 2007) and result in prolonged PT and INR in humans with subarachnoid hemorrhage (Mayor et al, 2013). Others have found, however, that RLIC did not affect serum levels of tissue plasminogen activator (tPA), nor tPA inhibitor antigen and activity, in healthy humans (Pedersen et al, 2012).…”

“…In order to correlate changes in learning with one or more blood biomarkers of RLIC, we measured changes in two hemostatic variables, and changes in the plasma concentration of several proteins representative of vascular endothelial mitogenic and inflammatory activity. These included prothrombin time and international normalized ratio (PT, INR; hemostatic pathway) (Mayor et al, 2013; Roesner et al, 2007; Stenzel-Poore et al, 2003; Warzecha et al, 2007), vascular endothelial growth factor (VEGF; endothelial pathway) (Kawata et al, 2001; Kimura et al, 2007), and tumor necrosis factor alpha and interleukin 6 (TNF-α, IL-6; inflammatory pathway) (Castillo et al, 2003; Ginis et al, 2002). Each participant underwent a blood draw before and after conditioning on D1, before conditioning on D3, and after conditioning at on D7.…”

“…Koch, Della-Morte, Dave, Sacco, & Perez-Pinzon, 2014). Given that repeated exposure to RLIC prolonged prothrombin time (PT) and international normalized ratio (INR) in humans with aneurysmal subarachnoid hemorrhage (Mayor et al, 2013), that RLIC led to increased serum vascular endothelial growth factor (VEGF) levels and endothelial progenitor cells in healthy adults (Kimura et al, 2007), and that a positive tumor necrosis factor-α / interleukin-6 (TNF-α / IL-6) ratio may be a marker for ischemic tolerance in humans with prior transient ischemic attack (Castillo et al, 2003), we sought to examine these specific biomarkers in our RLIC study.…”

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

“…The assay failed when thrombin generation peaked before it was detected by the reader. The assay failed in systemic samples at 1 h of reperfusion (n 5 1), 2 h of reperfusion (n 5 1), and 6 h of reperfusion (n 5 1) in three different control animals, and in two intervention animals at 4 h of reperfusion but did not affect aPTT (Mayor et al, 2013). Hence, previous clinical trials do not report consistent effects on secondary hemostasis by RIC.…”

“…Furthermore, RIC did not affect postoperative PT and international normalized ratio (INR) in a randomized controlled trial on living donor liver transplantation (Kim et al, ). However, RIC increased PT and INR when administered repeatedly in patients hospitalized for aneurysmal subarachnoid hemorrhage, but did not affect aPTT (Mayor et al, ). Hence, previous clinical trials do not report consistent effects on secondary hemostasis by RIC.…”