Recommended Approach for Patients Considering Platelet-Rich Plasma (PRP) Therapy
Patients considering PRP therapy should be informed that clinical preparations are poorly standardized, and current evidence does not strongly support its use for most conditions, with safety being the main advantage of this autologous treatment. 1
Understanding PRP and Current Evidence
- PRP is an autologous blood-derived product containing platelet concentrations at least 2-3 times above normal levels, including various growth factors that theoretically promote tissue healing 2
- The International Society of Thrombosis and Haemostasis (ISTH) guidelines indicate uncertainty about whether PRP preparations are clinically useful in tissue regenerative techniques 1
- Clinical preparations of PRP are poorly standardized, with wide variations in content, purity, and biological properties that impact clinical efficacy 1
- Autologous/allogeneic sterile PRP preparations are generally considered clinically safe, though adverse events including infections have been reported 1, 3
Condition-Specific Recommendations
Musculoskeletal Applications
- For hip osteoarthritis, the American College of Rheumatology/Arthritis Foundation guidelines recommend against PRP use 4
- The VA/DoD Clinical Practice Guidelines state there is insufficient evidence to recommend for or against PRP use in hip osteoarthritis due to inconsistent study results 4
- First-line treatments for osteoarthritis should include physical therapy, weight management, and appropriate use of oral or topical NSAIDs before considering PRP 4
Dermatologic Applications
- Some evidence suggests PRP may be effective for melasma treatment, either as standalone therapy or as an adjuvant treatment 1
- PRP has been investigated for hair-related applications, scar treatment, skin rejuvenation, and striae distensae, but high-quality evidence is limited 5
- For vitiligo, PRP has shown promise as an adjunct to laser therapies, with statistically significant improvements in repigmentation when used in combination approaches 1
Technical Considerations for PRP Administration
- EDTA anticoagulant should not be used for PRP preparation 1
- Platelet concentration, yield, and recovery depend on the centrifugation protocol and collection methods used 1
- PRP preparation methods vary widely regarding:
Recommendations for Patients
- Patients should be informed that PRP is not FDA-approved for most indications and is considered experimental for many conditions 1
- The term "PRP" is considered confusing, too general, and incomplete by expert consensus 1
- Patients should be cautious about direct-to-consumer marketing claims regarding PRP's regenerative potential 1
- Patients should understand that benefits remain largely unproven for many applications, while risks are generally low 7
- For conditions where conventional treatments are available and effective, these should be tried before considering PRP therapy 4
Important Considerations for Clinicians
- Clinicians should fully describe PRP preparation methodology when offering this treatment 1
- Treatment protocols should include details of the applied treatment, including number of platelets, number of applications, and duration of treatment 1
- Follow standardized post-treatment follow-up protocols to monitor outcomes and potential adverse events 1, 3
- Be aware that the most commonly reported adverse event is postoperative infection, likely due to contamination during preparation or administration 3
- Avoid describing minimally manipulated cell preparations as "stem cells" as this is misleading 1
Research Gaps and Future Directions
- High-quality multicenter randomized controlled trials with standardized PRP preparation protocols are needed 4
- Future studies should include biorepositories and standardized outcome measures 4
- Aspects of PRP use that need further determination include optimal volume, preparation method, activation technique, injection technique, timing, frequency, and rehabilitation protocols 7