Can Platelet-Rich Plasma (PRP) packs be used for treatment?

Can Platelet-Rich Plasma (PRP) Be Used for Treatment?

PRP can be used safely in clinical practice, but its routine use is not supported by strong evidence for most indications due to poor standardization, inconsistent clinical outcomes, and lack of high-quality trials demonstrating meaningful improvements in patient-centered outcomes like morbidity, mortality, or quality of life. 1

Safety Profile

• Autologous and allogeneic sterile PRP preparations are clinically safe with no serious adverse effects reported across multiple studies. 1, 2
• PRP has negligible immunogenicity when derived from autologous sources and can be produced efficiently in a sterile environment. 2
• Few complications have been documented in clinical use across various medical specialties. 3

Critical Limitations Affecting Clinical Use

Standardization Problems

• Clinical preparations of PRP are poorly standardized, with the term "PRP" being confusing, too general, and incomplete. 1, 4
• The content, purity, and biological properties of PRP vary widely and directly impact clinical efficacy. 1, 4
• Differences in preparation techniques (g-force, centrifugation time, activation method) result in significant variations in platelet yields, concentration, purity, viability, and activation status. 5
• Many trials fail to fully define the content, purity, and biological properties of platelet preparations, making interpretation of results difficult. 1

Evidence by Clinical Indication

Rotator Cuff Pathology

• Limited evidence does NOT support the routine use of PRP for rotator cuff tendinopathy or partial tears. 1
• Strong evidence does NOT support biological augmentation of rotator cuff repair with platelet-derived products for improving patient-reported outcomes (PROs). 1
• However, limited evidence suggests liquid PRP may decrease retear rates in the context of surgical repair, though this does not translate to improved functional outcomes. 1

Hip and Knee Osteoarthritis

• The VA/DoD guidelines were unable to recommend for or against the use of PRP for hip or knee osteoarthritis due to inconsistent study results. 1
• Some studies reported no benefit, while others reported small benefits from PRP for knee OA. 1
• For hip OA, PRP led to statistically significant pain reductions at 2 months compared to hyaluronic acid, but not at 6 and 12 months, with unclear clinical importance. 1
• No difference in function was found between PRP and hyaluronic acid at any follow-up period. 1

Assisted Reproduction

• Very low-certainty evidence exists about the effect of intrauterine or intraovarian PRP on assisted reproduction outcomes. 6
• The single study at low risk of bias showed no clear benefit for live birth (OR 1.10,95% CI 0.38-3.14) or miscarriage rates. 6
• Most studies had high risk of bias, small sample sizes, and insufficient safety data. 6

Facial Rejuvenation

• Insufficient evidence exists to support firm conclusions about PRP use for facial rejuvenation, either alone or combined with other treatments. 7
• Most primary studies were uncontrolled, and the available systematic reviews demonstrated poor methodological quality. 7
• Only low-certainty evidence suggests increased patient satisfaction when PRP is used as adjunct treatment (mean difference 0.63,95% CI 0.25-1.0). 7

Mechanism of Action (Theoretical)

• PRP delivers concentrated growth factors and cytokines from platelet α-granules that promote local angiogenesis, stem cell recruitment, cell migration, proliferation, and differentiation. 5, 4, 8
• Activated platelets create a fibrin scaffold serving as a temporary matrix for tissue repair. 5, 4
• These mechanisms are biologically plausible but have not been clearly demonstrated to translate into clinically meaningful outcomes. 5

Clinical Decision Algorithm

When considering PRP use:

1. Recognize that PRP is NOT a first-line treatment for any condition based on current evidence. 1

2. Consider PRP only after conventional treatments have failed and when patient preference strongly favors a trial of regenerative therapy. 1

3. Ensure proper informed consent emphasizing:

   • Lack of strong evidence for efficacy 1
   • Variability in preparation methods affecting outcomes 1, 5
   • Potential out-of-pocket costs for an unproven therapy 3

4. If proceeding with PRP:

   • Use commercial preparation devices according to manufacturer specifications 4
   • Maintain strict sterile technique during preparation and application 4
   • Avoid EDTA anticoagulant (use citrate or ACD instead) 1
   • Document the specific preparation protocol, platelet concentration, and activation method 1

Common Pitfalls to Avoid

• Do not present PRP as an evidence-based treatment with proven efficacy for most indications—the evidence remains uncertain or insufficient. 1
• Do not assume all PRP products are equivalent—preparation methods dramatically affect the final product and potential efficacy. 1, 5
• Do not use PRP as a substitute for proven therapies like corticosteroid injections for rotator cuff pain (which have moderate evidence for short-term benefit). 1
• Do not neglect to discuss alternative treatments with stronger evidence, such as physical therapy for osteoarthritis. 1