What is the recommended protocol for preparing platelet-rich plasma (PRP) in an ethylenediaminetetraacetic acid (EDTA) vial for scar treatment in a patient with a history of bleeding disorders or anticoagulant medication use?

How to Prepare PRP in EDTA Vial for Scar Treatment

Critical Warning: Do Not Use EDTA for PRP Preparation

EDTA anticoagulant should NOT be used for PRP preparation under any circumstances, as it causes platelet swelling, premature activation, and irreversible functional damage that renders the preparation ineffective for therapeutic use. 1, 2

Why EDTA is Contraindicated

• EDTA causes structural and functional platelet damage that prevents proper adhesion and spreading, which are essential mechanisms for tissue regeneration in scar treatment 3
• Platelet yield is significantly diminished when using EDTA anticoagulant compared to citrate-based alternatives, resulting in an inferior therapeutic product 4
• The International Society on Thrombosis and Haemostasis consensus guidelines explicitly state that EDTA should not be used for PRP preparation (median expert score of 8 out of 9) 1

Correct Protocol for PRP Preparation for Scar Treatment

Blood Collection and Anticoagulation

• Use trisodium citrate as the anticoagulant of choice, as it has few negative effects on PRP preparation and is the most widely recommended 1, 2
• Alternative acceptable anticoagulants include acid citrate dextrose (ACD) or citrate phosphate dextrose (CPD), including formulations with adenine (ACD-A, CPD-A) 5, 2
• Collect blood in plastic tubes to avoid contact activation 5
• Process blood at room temperature as soon as possible, preferably within 1 hour of collection 5

Centrifugation Protocol for Scar Treatment

Based on the most recent 2025 evidence for scar treatment specifically:

• Double-spin centrifugation protocol: First spin at 900 rpm for 5 minutes, followed by second spin at 2000 rpm for 15 minutes 1
• This protocol was used in randomized controlled trials demonstrating significant improvement in scar treatment outcomes 1
• Centrifuge at controlled room temperature to avoid precipitation and cold activation 5

Activation Step

• Activate PRP with 10% calcium chloride (CaCl₂) before application for scar treatment 1
• This activation step is essential for platelets to release their α-granule contents containing growth factors 2
• The resulting clot provides a scaffold to capture secreted proteins at the application site 2

Application Method for Optimal Scar Outcomes

• Combine PRP with microneedling for superior results rather than intradermal injection alone 1, 6
• The 2025 evidence shows that microneedling with PRP produces 3-fold better "excellent" outcomes compared to PRP injection alone for scar treatment 1
• Treatment protocol: 3-4 sessions at 3-4 week intervals 1, 6
• Use freshly prepared PRP within 4-6 hours for optimal results 5, 2

Special Considerations for Patients with Bleeding Disorders or Anticoagulant Use

While the expanded question mentions bleeding disorders or anticoagulant medication use, the evidence does not provide specific modifications to the PRP preparation protocol for these patients. However:

• PRP preparations are considered clinically safe when prepared under sterile conditions using autologous blood 1
• The standard citrate-based preparation protocol remains appropriate, as citrate itself is an anticoagulant that will be present in the final product 1, 2
• Clinical judgment is required regarding the safety of the procedure itself (blood draw and injection/microneedling) in patients with bleeding disorders, but this does not change the PRP preparation methodology

Common Pitfalls to Avoid

• Never use EDTA tubes even if they are readily available in your clinic—they will produce a non-functional PRP product 1, 3
• Do not store PRP at 4°C as cold activation might occur prematurely 5
• Avoid using PRP as monotherapy—combine with microneedling for significantly better scar treatment outcomes 1
• Do not skip the activation step with calcium chloride, as unactivated PRP will not release growth factors effectively 1