Skip to main content
SpringerLink
Log in

The effect of remote ischemic conditioning on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Objective

To explore the effect of remote ischemic conditioning (RIC) on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage.

Patients and methods

According to inclusion and exclusion standards, from October 2017 to June 2018, 30 consecutive patients of aneurysmal subarachnoid hemorrhage admitted to Intensive Care Unit, Department of Neurosurgery at Xuanwu Hospital, were given remote ischemic conditioning 5 times intervention to each patient within 7 days, and blood coagulation function testing, including prothrombin activity (PTA), prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (Fib), D-dimer, and thromboelastogram (TEG, including R, K, Angle, MA, EPL, LY30, A, CI, G, and A30) were performed for each patient before and after the RIC intervention, as well as venous ultrasound monitoring before and after the RIC intervention for detection of deep vein thrombosis (DVT). Transcranial Doppler evaluation (TCD), including cerebral blood flow of bilateral ACA, MCA, PCA and intracranial segments of VA, as well as BA and the ratios of MCA cerebral blood flow/terminal segment of ipsilateral ICA cerebral blood flow, was performed before and after RIC intervention; and fresh infarction was evaluated by head CT or MRI recheck after RIC intervention. Thirty cases without RIC intervention of matched age, gender, and Hunt Hess grade with aneurysmal subarachnoid hemorrhage were selected to compare coagulation function and cerebral blood flow using TCD with RIC group.

Results

(1) Comparing the data before and after the RIC intervention, there was no significant difference for APTT, Fib, and D-dimer (P > 0.05), while PTA decreased and PT increased slightly after intervention as well as INR (P < 0.05) but all still in normal reference values. (2) Comparing the data before and after the RIC intervention, within TEG parameters, only the R value increased with significant difference (P < 0.05) but still in normal reference value, while K, Angle, MA, EPL, LY30, A, CI, G, and A30 had no significant difference (P > 0.05). (3) Comparing the data before and after the RIC intervention, DVT was not detected on the pressurized limbs of patients. (4) Comparing the data before and after the RIC intervention, the cerebral blood flow of bilateral MCA, L-ACA, L-VA, and BA increased (P < 0.05), while the elevation ranges were all in 25%, and the other parameters showed no significant difference. (5) Head CT or MRI showed no fresh cerebral infarction after the RIC intervention. (6) Compared with the group without RIC intervention, the coagulation function and the cerebral blood flow evaluated by TCD of the RIC group showed no statistical difference (P > 0.05) except APTT and D-dimer decreased after RIC but still in normal reference values.

Conclusion

RIC showed no obvious effect on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage both after the intervention and compared with the non-intervention group. DVT was not detected on the pressurized limbs of patients and no fresh cerebral infarction was detected. This preliminary study confirmed the safety of RIC on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage, and the application of RIC on patients with aneurysmal subarachnoid hemorrhage needs further study to confirm and validate the safety and effectiveness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74(5):1124–1236

    Article  CAS  Google Scholar 

  2. Przyklenk K, Bauer B, Ovize M et al (1993) Regional ischemic ‘preconditioning’ protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation 87(3):893–899

    Article  CAS  Google Scholar 

  3. Schmidt MR, Rasmussen ME, Botker HE (2017) Remote ischemic conditioning for patients with STEMI. J Cardiovasc Pharmacol Ther 22(4):302–309

    Article  Google Scholar 

  4. Dezfulian C, Garrett M, Gonzalez NR (2013) Clinical application of preconditioning and postconditioning to achieve neuroprotection. Transl Stroke Res 4(1):19–24

    Article  Google Scholar 

  5. Lim SY, Yellon DM, Hausenlo DJ (2010) The neural and humoral pathways in remote ischemic preconditioning. Basic Res Cardiol 105(5):651–655

    Article  Google Scholar 

  6. Hausenloy DJ, Candilio L, Evans R et al (2015) Remote ischemic preconditioning and outcomes of cardiac surgery. N Engl J Med 373(15):1408–1417

    Article  CAS  Google Scholar 

  7. Li C, Xu M, Wu Y et al (2014) Limb remote ischemic preconditioning attenuates lung injury after pulmonary resection under propofol-remifentanil anesthesia: a randomized controlled study. Anesthesiology 121(2):249–259

    Article  CAS  Google Scholar 

  8. Zarbock A, Kellum JA (2016) Remote ischemic preconditioning and protection of the kidney--a novel therapeutic option. Crit Care Med 44(3):607–616

    Article  CAS  Google Scholar 

  9. Leung CH, Caldarone CA, Wang F et al (2015) Remote ischemic conditioning prevents lung and liver injury after hemorrhagic shock/resuscitation: potential role of a humoral plasma factor. Ann Surg 261(6):1215–1225

    Article  Google Scholar 

  10. Li C, Li YS, Xu M et al (2013) Limb remote ischemic preconditioning for intestinal and pulmonary protection during elective open infrarenal abdominal aortic aneurysm repair: a randomized controlled trial. Anesthesiology 118(4):842–852

    Article  CAS  Google Scholar 

  11. Yunoki M, Kanda T, Suzuki K et al (2017) Ischemic tolerance of the brain and spinal cord: a review. Neurol Med Chir (Tokyo) 57(11):590–600

    Article  Google Scholar 

  12. Zhao W, Meng R, Ma C et al (2017) Safety and efficacy of remote ischemic preconditioning in patients with severe carotid artery stenosis before carotid artery stenting. Circulation 135(14):1325–1335

    Article  Google Scholar 

  13. Meng R, Asmaro K, Meng L et al (2012) Upper limb ischemic preconditioning prevents recurrent stroke in intracranial arterial stenosis. Neurology 79(18):1853–1861

    Article  Google Scholar 

  14. van Gijn J, Kerr RS, Rinkel GJ (2007) Subarachnoid haemorrhage. Lancet 369(9558):306–318

    Article  Google Scholar 

  15. Lovelock CE, Rinkel GJ, Rothwell PM (2010) Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology 74(19):1494–1501

    Article  CAS  Google Scholar 

  16. Connolly ES Jr, Rabinstein AA, Carhuapoma JR et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43(6):1711–1737

    Article  Google Scholar 

  17. Diringer MN, Bleck TP, Claude Hemphill J 3rd et al (2011) Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care 15(2):211–240

    Article  Google Scholar 

  18. Rabinstein AA, Lanzino G, Wijdicks EF (2010) Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage. Lancet Neurol 9(5):504–519

    Article  CAS  Google Scholar 

  19. Kim YW, Zipfel GJ, Ogilvy CS et al (2014) Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 74(4):351–358

    Article  Google Scholar 

  20. Mayor F, Bilgin-Freiert A, Connolly M (2013) Effects of remote ischemic preconditioning on the coagulation profile of patients with aneurysmal subarachnoid hemorrhage: a case-control study. Neurosurgery 73(5):808–815

    Article  Google Scholar 

  21. Gonzalez NR, Connolly M, Dusick JR (2014) et al. Phase I clinical trial for the feasibility and safety of remote ischemic conditioning for aneurysmal subarachnoid hemorrhage. Neurosurgery 75(5):590–598

    Article  Google Scholar 

  22. Laiwalla AN, Ooi YC, Liou R et al (2016) Matched cohort analysis of the effects of limb remote ischemic conditioning in patients with aneurysmal subarachnoid hemorrhage. Transl Stroke Res 7(1):42–48

    Article  Google Scholar 

  23. Gonzalez NR, Hamilton R, Bilgin-Freiert A et al (2013) Cerebral hemodynamic and metabolic effects of remote ischemic preconditioning in patients with subarachnoid hemorrhage. Acta Neurochir Suppl 115:193–198

    PubMed  Google Scholar 

  24. Koch S, Gonzalez N (2013) Preconditioning the human brain: proving the principle in subarachnoid hemorrhage. Stroke 44(6):1748–1753

    Article  Google Scholar 

Download references

Funding

This work was supported by a grant from Beijing Municipal 215 High-level Health Professional Personnel Academic Talent Project (2015-3-062, Dr. XU Y), a grant from Scientific Research Common Program of Beijing Municipal Commission of Education (KM201710025015, Dr. XU Y), a grant from Beijing Municipal Science and Technology Project of China (Z151100004015095, Dr. XU Y), and a grant from the Intramural Research Program of Basic and Clinical Medical Sciences, Xuanwu Hospital, Capital Medical University (XWYY201709, Dr. QI M). The sponsors had no role in the design or conduct of this research.

Author information

Author notes

  1. Yueqiao Xu and Meng Qi contributed equally to this work.

Authors and Affiliations

  1. Intensive Care Unit, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

    Yueqiao Xu, Meng Qi, Ning Wang, Lidan Jiang, Wenjin Chen, Xin Qu & Weitao Cheng

Authors
  1. Yueqiao Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meng Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ning Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lidan Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenjin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xin Qu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Weitao Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each author has made an important scientific contribution to the study and is thoroughly familiar with the primary data. All authors listed have read the complete manuscript and have approved submission of the paper.

Corresponding author

Correspondence to Yueqiao Xu.

Ethics declarations

This study was approved by the Ethical Review Board of Xuanwu Hospital, Capital Medical University, prospectively and consecutively including patients of subarachnoid hemorrhage admitted to Intensive Care Unit of Department of Neurosurgery in Xuanwu Hospital from October 2017 to June 2018.

Conflict of interest

All authors declare that they have no conflicts of interest.

Additional information

We declare that submitted manuscript does not contain previously published material and are not under consideration for publication elsewhere. The manuscript is truthful original work without fabrication, fraud or plagiarism.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, Y., Qi, M., Wang, N. et al. The effect of remote ischemic conditioning on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage. Neurol Sci 41, 335–340 (2020). https://doi.org/10.1007/s10072-019-04057-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-019-04057-1

Keywords

Search

Navigation