Proteomic signatures of intermittent pneumatic compression in patients with large artery atherosclerotic stroke

Intermittent pneumatic compression (IPC) is routinely used after stroke for venous thromboembolism prophylaxis, yet its molecular mechanisms remain elusive. In a single-blind randomized pilot trial, 44 patients with large-artery atherosclerotic ischemic stroke were assigned to bilateral IPC twice daily (n = 22) or unilateral compression once daily (n = 22) for 7 (SD = 2) days. Cardiovascular proteins were quantified with the Olink platform, and treatment-specific changes were identified using a prespecified triple orthogonal screening strategy. IPC was associated with 12 treatment-specific proteins, 93.3% of which increased after intervention. ANGPT1 and SOD2 were prominent candidates, mapping to angiogenesis, antioxidant, and inflammation pathways, including Ras signaling, correlating with NIHSS and ESRS scores. These hypothesis-generating data suggest IPC modulates defined protein networks (Ras-ANGPT1-related and SOD2-mediated antioxidant pathways) that may support mechanistic and precision rehabilitation studies, pending validation in larger cohorts.