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

Abstract

Ischemic conditioning induced by nonlethal cycles of tissue ischemia and reperfusion attenuates ischemia–reperfusion injury. The objective of this study is to systematically review the effects of local and remote ischemic conditioning on laboratory parameters of hemostasis and the clinical outcomes of thromboembolism or bleeding in patients undergoing surgery or cardiac procedures. PubMed and Embase were searched for relevant human trials published in English between January 1, 1986, and September 7, 2016, and additional studies were identified from reference lists. Data on laboratory parameters of hemostasis, thromboembolism, and bleeding were extracted for qualitative synthesis. In total, 69 studies were included; of these, 53 were randomized controlled trials (RCTs) and 11 were meta-analyses. Local and remote ischemic conditioning reduced platelet activation in patients undergoing cardiac procedures. Local ischemic conditioning did not reduce the thromboembolic risk in patients undergoing surgery or cardiac procedures. Remote ischemic conditioning reduced the incidence of arterial thromboembolism after surgery or cardiac procedures in 3 out of 28 RCTs and 4 out of 5 meta-analyses. Local and remote ischemic conditioning did not increase operative bleeding. In conclusion, ischemic conditioning reduced platelet activity without increasing the risk of bleeding in patients undergoing surgery or cardiac procedures. Limited evidence supports the proposal that ischemic conditioning reduces the incidence of arterial thromboembolism in patients undergoing surgery or cardiac procedures.

Effect of remote ischemic preconditioning on hemostasis and fibrinolysis in head and neck cancer surgery: A randomized controlled trial

“…RIPC attenuates platelet activation in patients undergoing heart catheterization procedures [5, 6] and long-term remote ischemic conditioning increases fibrinolysis in patients with cardiovascular disease [7] and cerebrovascular disease [8]. Correspondingly, a recent systematic review shows that remote ischemic conditioning may reduce the risk of thrombosis in patients undergoing surgery or cardiac procedures [9]. Regarding cancer surgery, RIPC has been shown to reduce the incidence of postoperative ischemic lesions in patients undergoing brain tumor resection [10].…”

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

“…However, all flaps were viable following 7 h reperfusion evaluated by Doppler measurement and clinical observation except one flap in the control group. Four 5‐min cycles of extremity ischemia–reperfusion have been administered in most clinical trials on RIC in cardiovascular surgery and procedures (Krag & Hvas, ). Hence, three 10‐min cycles of limb ischemia–reperfusion in the present study might not be the optimal protocol.…”

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“…The review by Krag and Hvas summarizes the existing evidence of the effects of local or remote ischemic conditioning on laboratory hemostasis measures as well as the incidence of thromboembolism and bleeding in patients undergoing surgery or cardiac procedures. 16 This systematic review points to the fact that although conditioning consistently reduced platelet activation in patients undergoing cardiac procedures, the intervention did not increase bleeding risk, but notably the majority of studies also indicated that the intervention did not reduce arterial thromboembolic risk in surgery or other cardiac procedures. 16 Thus, the possible role of ischemic conditioning during surgery still needs further investigations.…”