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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 2  |  Issue : 4  |  Page : 178-179

Platelet-rich plasma procedures and the responsible discontinuation of antithrombotic therapy


Eduardo Anitua Foundation for Biomedical Research; BTI Biotechnology Institute ImasD, Vitoria, Spain

Date of Submission24-Jul-2019
Date of Decision23-Aug-2019
Date of Acceptance22-Sep-2019
Date of Web Publication13-Dec-2019

Correspondence Address:
Dr. Eduardo Anitua
Eduardo Anitua Foundation for Biomedical Research, Jacinto Quincoces, 39, 01007 Vitoria
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisprm.jisprm_59_19

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How to cite this article:
Anitua E, Padilla S, Prado R. Platelet-rich plasma procedures and the responsible discontinuation of antithrombotic therapy. J Int Soc Phys Rehabil Med 2019;2:178-9

How to cite this URL:
Anitua E, Padilla S, Prado R. Platelet-rich plasma procedures and the responsible discontinuation of antithrombotic therapy. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2020 Feb 19];2:178-9. Available from: http://www.jisprm.org/text.asp?2019/2/4/178/272895



Sir,

We have read with great interest and concern the case report by Jayaram et al. entitled, “Platelet-rich plasma (PRP) protocols can potentiate vascular emboli: Contraindications to PRP.”[1] The authors describe a case in which a patient suffers a cerebral microembolism as a result of antithrombotic treatment cessation to perform a PRP procedure to treat lateral epicondylitis.

We agree with the authors of this case report in describing all adverse reactions associated with PRP therapeutics. Like any medical treatment, side effects may occur due to the administration procedure or the particular medicinal product used. In this case, side effects have occurred due to the discontinuation of prophylactic antithrombotic treatment with aspirin (324 mg/day). It is important to note that this interruption was made by the patient himself without the knowledge of a cardiologist who prescribed such treatment. Rather than leaving a self-referral to the patient, a medical interconsultation protocol would be desirable to avoid cases like this.

We believe, however, from the title of this case report,[1] that the reader may link the vascular emboli to the use of PRP in a cause/effect relationship. It is clear from reading the case report that this side effect was related to the discontinuation of prophylactic antithrombotic treatment and not to the use of PRP. We consider that the title would have been more appropriate and less alarmist if it had somehow described the context of the case report. For example, “vascular emboli due to discontinuation of antithrombotic treatment to carry out a PRP procedure.”

There is a need to create clinical evidence and to develop clinical guidelines about the effect of antithrombotic treatment on the efficacy of PRP therapy. Di Matteo et al.[2] have described successful knee osteoarthritis treatment with PRP in a patient medicated for 9 years with acetylsalicylic acid, where the antiplatelet therapy had not been interrupted. A recent in vitro study has shown the effect of aspirin on the properties of PRP and has also shown that activating PRP may mitigate the effect of aspirin on the PRP.[3]

Our group has already shown interest in this topic and in the efficacy of PRP treatment in patients undergoing prophylactic antithrombotic treatment.[4] In previous study, the amount of growth factors (platelet-derived growth factor-AB, vascular endothelial growth factor, transforming growth factor-beta 1, insulin-like growth factor-1, and hepatocyte growth factor) has been compared in a leukocyte-free PRP (plasma rich in growth factors [PRGF]) obtained from patients taking acetylsalicylic acid, acenocoumarol, or glucosamine sulfate, as well as from a control group who were taking no medication.[5] PRGF was activated with 10% calcium chloride solution. The results showed the absence of significant differences in regard to the content of these growth factors in the PRGF.

From preventive point-of-view, the patients under antithrombotic therapy can benefit from a successful PRP treatment without discontinuation of their antithrombotic drugs. However, if the clinical evidence shows a negative effect of these drugs on the efficacy of PRP, treatment interruption should be done under the approval of the prescribing physician (as in the daily clinical practice). Finally, we would like to emphasize that although platelet function decreases due to antithrombotic drugs, there are more components in the PRP that have a great responsibility in their efficacy, such as a myriad of plasma molecules, and not least the fibrin that acts as a scaffold for controlled release of growth factors and other bioactive molecules.[6]

Financial support and sponsorship

Nil.

Conflicts of interest

The authors declare that EA is the Scientific Director of and SP and RP are scientists at BTI Biotechnology Institute ImasD, a biotechnology company that investigates in the fields of regenerative medicine and PRGF-Endoret Technology.



 
  References Top

1.
Jayaram P, Yeh P, Cianca J. Platelet-rich plasma protocols can potentiate vascular emboli: Contraindications to platelet-rich plasma. J Int Soc Phys Rehabil Med 2019;2:103.  Back to cited text no. 1
  [Full text]  
2.
Di Matteo B, Filardo G, Lo Presti M, Kon E, Marcacci M. Chronic anti-platelet therapy: A contraindication for platelet-rich plasma intra-articular injections? Eur Rev Med Pharmacol Sci 2014;18:55-9.  Back to cited text no. 2
    
3.
Jayaram P, Yeh P, Patel SJ, Cela R, Shybut TB, Grol MW, et al. Effects of aspirin on growth factor release from freshly isolated leukocyte-rich platelet-rich plasma in healthy men: A prospective fixed-sequence controlled laboratory study. Am J Sports Med 2019;47:1223-9.  Back to cited text no. 3
    
4.
Anitua E, Prado R, Orive G. Platelet-rich plasma therapy and antithrombotic drugs. Pain Physician 2017;20:E335-6.  Back to cited text no. 4
    
5.
Anitua E, Troya M, Zalduendo M, Orive G. Effects of anti-aggregant, anti-inflammatory and anti-coagulant drug consumption on the preparation and therapeutic potential of plasma rich in growth factors (PRGF). Growth Factors 2015;33:57-64.  Back to cited text no. 5
    
6.
Anitua E, Nurden P, Prado R, Nurden AT, Padilla S. Autologous fibrin scaffolds: When platelet- and plasma-derived biomolecules meet fibrin. Biomaterials 2019;192:440-60.  Back to cited text no. 6
    




 

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