PRP treatment: When caution is advised – A comprehensive guide to contraindications for medical professionals and patients

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PRP treatment: When caution is advised – A comprehensive guide to contraindications for medical professionals and patients

The fascination of PRP therapy and the question of suitability

In modern medicine, we are constantly looking for ways to mobilize and optimize the body's own healing powers. One of the most fascinating and promising methods, which has become increasingly important in recent years, is PRP therapy - treatment with platelet-rich plasma. From orthopaedics to dermatology and aesthetic medicine, PRP is being hailed as a real game-changer that can be used to treat a wide range of conditions and regenerate tissue. The idea that our own blood holds the keys to our healing is not only scientifically sound but also intuitively appealing.

However, as with any medical intervention, however effective it may be, one crucial question arises: is PRP treatment suitable for everyone? The answer is a clear "no". As broad as the range of applications of PRP is, it is important to know the limits and potential risks. After all, patient safety is always the top priority. This comprehensive guide is aimed equally at doctors who want to advise and treat their patients in the best possible way and at patients who want to find out more about this innovative therapy. We will explore the fascinating world of PRP treatment, examine its detailed process and then address the critical question: For whom is PRP treatment not recommended? Let's dive into the subject matter to make informed and safe decisions.

PRP treatment in detail: a look behind the scenes of autologous blood therapy

Before we look at the contraindications, it is essential to understand the principle and procedure of PRP treatment in detail. What exactly is this "platelet-rich plasma" and how is it obtained in order to develop its healing effect?

However, as with any medical intervention, however effective it may be, one crucial question arises: is PRP treatment suitable for everyone? The answer is a clear "no". As broad as the range of applications of PRP is, it is important to know the limits and potential risks. After all, patient safety is always the top priority. This comprehensive guide is aimed equally at doctors who want to advise and treat their patients in the best possible way and at patients who want to find out more about this innovative therapy. We will explore the fascinating world of PRP treatment, shed light on its detailed procedure and then address the critical question: For whom is PRP treatment not recommended? Let's delve into the subject matter to make informed and safe decisions.

PRP treatment

What is PRP and how does it work?

PRP stands for platelet-rich plasma. This is a concentrate of blood platelets (thrombocytes) that is obtained from the patient's own blood.

These platelets are not only responsible for blood clotting, but also play a central role in wound healing and tissue regeneration. They contain a wealth of growth factors, cytokines and other bioactive proteins that are released when they are activated.

These messenger substances stimulate cell proliferation, promote the formation of new blood vessels (angiogenesis), reduce inflammation and support the regeneration of damaged tissue such as cartilage, tendons, ligaments, muscles and skin. Basically, PRP is the body's own healing booster, which is used specifically where the body needs support for repair.

The process step by step: From blood to healing

1.Blood collection: the first step towards personalized medicine

Every PRP treatment begins with a simple blood sample, comparable to a routine blood draw. A small amount of blood - typically between 10 and 60 milliliters, depending on the planned application and the required volume of PRP - is taken from the patient's vein. This step is not only uncomplicated, but also crucial, as the patient's own blood forms the unique basis for the subsequent, highly effective PRP. It is the epitome of personalized medicine, as no exogenous substances are used.

2.Centrifugation: the magic of separation with the right tools

Once the blood has been collected, it is immediately transferred to special PRP tubes. This is where the VI PRP-PRO PRP-tubes from prpmed.de come into play. These tubes are no ordinary blood tubes; they are at the heart of the PRP harvesting process. Made from robust glass and with an impressive wall thickness of 2.4 mm, they not only provide extra stability, but are also precisely designed to ensure optimal separation of blood components. This is crucial for the quality and concentration of the subsequent PRP.

  • Below: The heavier red blood cells (erythrocytes) settle at the bottom of the tube.
  • In the middle: A thin, yellowish layer forms on top - the platelet-rich plasma (PRP), which also contains a small amount of white blood cells. This layer is the actual "gold" of the treatment.
  • Above: The platelet-poor plasma (PPP), which also contains proteins and other substances, but significantly fewer platelets, floats at the very top.

3.Obtaining the PRP: the elixir of regeneration

After the centrifugation process, the concentrated platelet-rich plasma (PRP) is carefully and sterilely removed from the tube. This golden-yellow, clear liquid is now ready for use. It is rich in the aforementioned growth factors and bioactive molecules, which play a crucial role in cell regeneration and tissue repair.

4.The application: targeted delivery of the healing powers

  • The PRP obtained is then injected into the area to be treated. The application method varies depending on the indication:
  • Orthopaedics: direct injection into joints (e.g. knee for osteoarthritis), tendons (e.g. Achilles tendon for tendinopathy), ligaments or muscles for injuries.
  • Dermatology/aesthetics: Microinjections into the skin (e.g. for skin rejuvenation, scar treatment) or into the scalp (for hair loss).
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How PRP works: the body's own healing booster in action

The therapeutic effect of PRP is based on the release of growth factors stored in the platelets. As soon as the PRP is injected into the target tissue, the platelets are activated and release these messenger substances. These growth factors initiate and accelerate a cascade of healing processes:

  • Cell proliferation and differentiation: they stimulate the growth and proliferation of cells necessary for tissue repair, such as fibroblasts, chondrocytes and osteoblasts.
  • Angiogenesis: They promote the formation of new blood vessels, which improves the supply of oxygen and nutrients to the damaged tissue and thus accelerates healing.
  • Collagen synthesis: They stimulate the production of collagen, an essential protein for the structure and strength of tissues.
  • Inflammation modulation: Although PRP may initially trigger a mild inflammatory response, it helps to modulate and reduce chronic inflammation in the long term.

The result is accelerated healing of tissue damage, reduced pain and improved function. As the treatment uses only the body's own substances, the risk of allergic reactions or rejection is extremely low, making PRP an attractive option in regenerative medicine. However, precisely because it is a medical treatment, careful patient selection is essential.

For whom is PRP treatment not recommended? The key contraindications

PRP therapy is a fascinating option in regenerative medicine, but its use requires careful patient selection. Not every patient is a suitable candidate for this treatment. Understanding the contraindications is crucial to ensure patient safety and avoid undesirable outcomes. The following highlights the main medical conditions and factors for which PRP treatment is not recommended or even contraindicated.

For whom is PRP treatment not recommended? The key contraindications

Medical conditions: When the body says "no"

  • Blood clotting disorders and anticoagulant therapy: As PRP is based on the activation of blood platelets, blood clotting disorders are an absolute contraindication. Patients with congenital or acquired coagulation disorders (e.g. haemophilia) or those taking anticoagulant medication (anticoagulants such as warfarin, DOACs or antiplatelet agents such as clopidogrel) are at increased risk of bleeding and haematomas. The effectiveness of PRP treatment may also be impaired as platelet function is impaired. A careful medical history regarding medication is essential here [1, 2].
  • Active infections and sepsis: Any form of active infection, whether local at the planned injection site or systemic (e.g. sepsis, fever), is a contraindication. Injecting PRP into an infected area could promote the spread of the infection or exacerbate the inflammatory reaction. In the case of systemic infections, the body is already weakened and PRP treatment would represent an additional burden [1, 2].
  • Cancer and malignant diseases: This is one of the most critical contraindications. Growth factors contained in PRP can potentially stimulate the growth of tumor cells. Therefore, PRP treatment is strictly contraindicated in patients with active cancer or a history of cancer, especially near the treatment area. Extreme caution is also required for benign tumors or precancerous lesions and an individual risk-benefit assessment is essential [1, 3].
  • Autoimmune diseases: In autoimmune diseases (e.g. rheumatoid arthritis, lupus erythematosus), the body's immune system mistakenly reacts against its own tissues. Although PRP may have inflammation-modulating properties, there are concerns that the stimulation of the immune system by the growth factors may in some cases cause a worsening of the autoimmune disease. The data situation here is complex and individual consideration by the treating physician is necessary [1].
  • Pregnancy and lactation: Although there is no direct evidence of adverse effects of PRP on pregnancy or lactation, comprehensive studies on safety in these patient groups are lacking. As a precautionary measure, PRP treatment is generally not performed on pregnant or breastfeeding women [1].
  • Severe systemic diseases: Patients with severe, uncontrolled systemic diseases such as decompensated heart failure, severe renal or hepatic insufficiency or uncontrolled diabetes mellitus are often unable to tolerate the stress of a medical procedure or have a limited ability to heal. In such cases, PRP treatment should be avoided [1].
  • Thrombocytopenia and other hematologic disorders: Thrombocytopenia (insufficient platelet count) or platelet dysfunction would negate the efficacy of PRP treatment as there are not enough functional platelets available for the collection of PRP. Other severe hematologic diseases may also be a contraindication [1, 2].
  • Fever and acute illnesses: As with any elective medical procedure, PRP treatment should be postponed in patients with fever or acute febrile illnesses until their health has stabilized.

Taking medication: When medication influences therapy

Certain medications can impair the function of the blood platelets or reduce the effect of PRP treatment:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen, diclofenac or naproxen can inhibit platelet function and should ideally be discontinued at least 5-7 days before PRP treatment. However, this should always be agreed with the attending physician, especially if the NSAIDs are being taken for important medical reasons [4].
  • Corticosteroids: The systemic or local application of corticosteroids can antagonize the anti-inflammatory effect of PRP and inhibit cell proliferation. PRP treatment should not be carried out shortly after a corticosteroid injection in the same area [4].

Unrealistic expectations: The psychological contraindication

Although not a medical contraindication in the classic sense, unrealistic patient expectations are an important factor that can influence the success of treatment. Comprehensive information about the potential results, the limitations of the therapy and the need for compliance (e.g. rest after treatment) is crucial to avoid disappointment and ensure patient satisfaction. A patient who has unrealistic expectations despite being informed may not be a suitable candidate for treatment.

The importance of careful patient selection and anamnesis

The list of contraindications makes it clear that successful and safe PRP therapy begins long before the actual injection - it starts with thorough and conscientious patient selection. This is the primary responsibility of the treating physician.

The doctor's responsibility: more than just an injection

Every doctor who offers PRP treatments must take a detailed medical history and carry out a comprehensive physical examination. This includes:

  • Taking a complete medical history: current and past medical conditions, especially those that could affect blood clotting, the immune system or the ability to heal.
  • Medication history: A detailed list of all medications, supplements and herbal supplements the patient is taking to identify potential interactions or contraindications.
  • Laboratory tests: Blood tests (e.g., CBC, coagulation parameters) may be required to rule out hematologic contraindications.
  • Manage realistic expectations: Open and honest communication about the chances of success, possible side effects and the need for follow-up care is essential. The doctor should ensure that the patient fully understands the therapy and its limitations.

Patient information: Your right to know

It is equally important for patients to actively participate in the information process. Ask questions, express concerns and make sure you get all the information you need to make an informed decision. A good doctor-patient relationship based on trust and open communication is the cornerstone of any successful treatment.

Scientific evidence: studies and research on PRP contraindications

The recommendations regarding contraindications for PRP treatments are based on clinical experience and a growing number of scientific studies. Although research in the field of PRP remains dynamic, there is already sound evidence to support the need for careful patient selection.

Summary of relevant studies:

  1. Coagulation disorders and anticoagulants: Several studies and consensus recommendations emphasize the increased risk of bleeding in patients with coagulation disorders or taking anticoagulants. A review by Sánchez et al. (2014) emphasizes that platelet function is crucial for the efficacy of PRP and that drugs that impair this function are therefore a contraindication [1].
  2. Infections: The risk of spreading infection through injections into contaminated areas is an established principle in medicine. A study by Everts et al. (2020) on the safety of PRP injections emphasizes the need to rule out active infections to avoid serious complications [2].
  3. Malignant diseases: The concern that growth factors may promote tumor growth is a key issue. A systematic review by Dhillon et al (2014) discusses the potential risks of growth factors in cancer patients and advises caution in the use of PRP in this patient group [3]. Although direct evidence of PRP-induced tumor progression in humans is scarce, the theoretical possibility remains and justifies the strict contraindication.
  4. Systemic diseases and immunosuppression: Patients with severe systemic diseases or immunosuppression often have a limited ability to heal and an increased risk of infection. A publication by Marx (2004), although older, lays the foundations for understanding the role of growth factors in bone healing and indirectly the importance of a healthy physiological state for the PRP effect [4].

Current research and outlook:

Research continues to focus on deciphering the exact mechanisms of PRP action and further refining the optimal areas of application and safety profiles. Future studies are expected to provide more precise guidelines for patient selection and management of contraindications. The development of standardized protocols for PRP collection and application, as supported by high-quality products such as the VI PRP-PRO tubes from https://prpmed.de/en/, will also help to increase the safety and predictability of results.

Conclusion: Informed decisions for safe PRP therapy

PRP therapy is undoubtedly a promising and innovative treatment option that has the potential to revolutionize healing and regeneration in many medical fields. However, as with any powerful tool, the key to its success lies in its responsible and informed use. The question "For whom is PRP treatment not recommended?" is not a side note, but the foundation of safe and ethical practice.

For physicians, this means the obligation to take a meticulous medical history, provide comprehensive information and critically assess the individual patient profile. It is important not only to see the potential benefits, but also to take the risks and contraindications seriously and act accordingly. The use of high-quality products, such as the VI PRP-PRO tubes from https://prpmed.de/en/, supports the quality and safety of the entire process.

For patients, it means actively informing themselves, asking questions and maintaining open communication with their doctor. Making an informed decision based on a clear understanding of their own medical situation and the specifics of PRP therapy is the best way to achieve a positive treatment outcome. Remember: your health is your most valuable asset, and safe treatment is always the best treatment.

The future of PRP therapy is bright, characterized by continuous research and growing understanding. By recognizing both the limitations and possibilities of this fascinating method, we can realize its full potential for the benefit of patients.

References

[1] Sánchez, M., et al. (2014). Intraosseous infiltration of platelet-rich plasma for severe knee osteoarthritis. Arthrosc Tech, 3(6), e713-e717. https://pubmed.ncbi.nlm.nih.gov/25685680/

[2] Everts, P. A., et al. (2020). Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in Orthopedics and Sports Medicine. Int J Mol Sci, 21(20), 7794. https://www.mdpi.com/1422-0067/21/20/7794

[3] Dhillon, M. S., et al. (2014). Orthobiologics and platelet rich plasma. Indian J Orthop, 48(1), 1-9. https://pubmed.ncbi.nlm.nih.gov/24600055/

[4] Marx, R. E. (2004). Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg, 62(4), 489-496.

https://pubmed.ncbi.nlm.nih.gov/15085519/

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