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Is Antiplatelet Therapy Contraindicated After Platelet-Rich Plasma Treatment? A Narrative Review


Background: Antiplatelet therapies are often withheld before and after platelet-rich plasma product (PRPP) administration due to theoretical concerns that therapies that inhibit the function of platelets would inhibit the effects of PRPP.

Purpose/hypothesis: The purpose of this study was to evaluate the effect that antiplatelet therapies have on the ability of PRPP to stimulate wound healing and tissue regeneration. Our hypothesis was that antiplatelet therapies would have highly heterogeneous effects on the biological activity of PRPP.

Study design: Narrative review.

Methods: The Medline database was searched via PubMed to identify all studies related to PRPP and antiplatelet therapies, yielding 1417 publications. After the search was confined to articles published after 1995, there were 901 articles remaining. All abstracts were then screened to identify animal or human clinical studies that focused on growth factor or inflammatory cytokine production or treatment outcomes. We limited our analysis to studies reporting on orthopaedic pathologies and in vitro studies of antiplatelet therapies. Ultimately, 12 articles fit the search criteria.

Results: The majority of studies reported on the use of nonsteroidal anti-inflammatory drugs as antiplatelet therapy. The majority of studies were in vitro analyses of growth factors, inflammatory cytokines, or cell viability, whereas 1 study examined clinical outcomes in an animal model. None of the studies investigated clinical outcomes in humans. All of the studies showed no effect or mixed effects of antiplatelet therapies on PRPP efficacy. One study showed PRPP recovery to baseline function after a 1-week washout period.

Conclusion: The literature did not provide support for the common clinical practice of withholding antiplatelet therapies in patients being treated with PRPP.

Keywords: NSAIDs; biological healing enhancement; growth factors/healing enhancement; platelet-rich plasma.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.A.R. has received consulting fees from Flexion Therapeutics and Advanced Medical, honoraria from Fidia Pharma USA, royalties or license from Zimmer Biomet Holdings, and nonconsulting services from Smith & Nephew; has stock options from Ortho RTI, Rotation Medical, and Cayenne Medical; and is a paid associate editor for The American Journal of Sports Medicine. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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