Is Remote Ischemic Conditioning Safe In Clinical Practice : A Systematic Review

Introduction: Remote ischemic conditioning (RIC) has been investigated for its protective effect for heart disease, stroke prevention, etc. However, the safety and tolerability of RIC have not been systematically investigated. We aimed to conduct a systematic review to evaluate the RIC-related adverse effects. Methods: We searched PubMed up to June 2017 using the following keywords: “remote ischemic postconditioning”; “remote ischemic preconditioning”; “remote ischemic conditioning” and “remote ischemic preconditioning”. We included any clinical studies with adult subjects. Exclusion criteria were conditioning not performed on remote limbs and not ischemic conditioning. We extracted adverse effects from each study, and summarize the rate of these adverse effects. Results: 131 studies with 8,895 subjects were included. Six disease conditions were investigated. Only 10 studies reported RIC related adverse effects in the manuscripts while 47 studies stated no RIC-related adverse effects were observed. The highest pressure was 600 mmHg, and lowest pressure was 15 mmHg above systolic blood pressure. The median duration for each session is 5 minutes and the median number of sessions is 4. “Skin petechiae” was the most common adverse effects (50, 0.56%); followed by “discomfort or pain around limbs” (22, 0.24%) and deep-venous thrombosis (2, 0.02%). Sixteen (0.18%) patients did not tolerate the procedure and discontinued from the study. Conclusions: Our system review concluded that, in general, RIC was well tolerated and its related adverse events are minor with low incidence rates.