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PRP therapy: contraindications, risks and medical assessment
PRP is used and investigated in different medical fields. It is not suitable for every patient. Indication, anamnesis, comorbidities, medication, laboratory values and the physician’s individual assessment are decisive.
Note: This article provides general professional information. It does not replace medical diagnosis, individual patient counselling or a treatment decision.
What is PRP?
PRP stands for platelet-rich plasma. It is plasma obtained from autologous blood with a higher platelet concentration than whole blood. Platelets are involved in coagulation and contain bioactive components that are studied in connection with tissue responses, wound-healing processes and regenerative questions. PRP is not a uniformly standardized product. Its composition can vary depending on the system, tube, centrifugation protocol, leukocyte content, platelet concentration, activation and collection technique. Study results therefore cannot simply be transferred to every PRP protocol.
Process of a PRP application
Blood collection
Venous blood is collected first. The required volume depends on the PRP system, the planned application and the required plasma volume.
Centrifugation
The blood is centrifuged in suitable tubes or a designated system. For comparability, the RCF/g value is more relevant than RPM alone.
Collection of the plasma fraction
The intended plasma fraction is collected according to protocol. The intended leukocyte profile depends on the procedure and indication.
Qualified application
Contraindications, medication, signs of infection, informed consent and hygiene requirements must be checked beforehand.
PRP contraindications: when caution is required
The following situations may be contraindications or require careful medical assessment. The list is not exhaustive. The patient situation, indication and instructions for use of the system remain decisive.
Active infections, fever and sepsis
In elective settings, PRP should usually be postponed in the presence of active infection, especially in the planned treatment area, fever, systemic signs of infection or sepsis.
Coagulation disorders
Relevant coagulation disorders or a clinically relevant bleeding tendency may argue against PRP. Unclear histories require medical assessment.
Anticoagulants and antiplatelet agents
Medication affecting coagulation requires careful evaluation and must not be paused or stopped without medical instruction.
Thrombocytopenia and hematologic disorders
Low platelet count, platelet dysfunction or hematologic disease can limit the ability to obtain an appropriate PRP preparation.
Malignancies
Active cancer requires particular caution. In patients with a history of cancer, the decision should be individual and may require oncological consultation.
Autoimmune disease and immunosuppression
Autoimmune disease is not automatically an absolute contraindication. Disease activity, organ involvement, medication and general condition are relevant.
Pregnancy and breastfeeding
For many PRP applications during pregnancy and breastfeeding, robust data are limited. Non-medically necessary aesthetic applications should generally be postponed.
Severe systemic disease
Severe or decompensated systemic disease may argue against PRP, for example severe organ insufficiency, poor general condition or poorly controlled diabetes.
Medication before PRP
Several medicines can influence coagulation, platelet function or tissue response. These include anticoagulants, antiplatelet agents, NSAIDs, corticosteroids and certain oncological or immunosuppressive therapies. Whether medication should be paused cannot be decided generally and must be assessed medically. Patients should never stop medication on their own.
Risks and possible side effects
PRP is obtained from autologous blood, but the application is not risk-free. Depending on the route of application, possible effects include pain or pressure at the puncture site, hematoma, swelling, redness, local irritation, infection, temporary increase in symptoms or circulatory reactions related to blood collection or injection. Patients should be informed about warning signs such as increasing pain, marked redness, fever, discharge or significant swelling.
Anamnesis and patient selection
- plausible indication
- signs of infection or fever
- coagulation disorders or bleeding history
- anticoagulants or antiplatelet agents
- thrombocytopenia or hematologic disease
- active or previous malignancy
- pregnancy or breastfeeding
- severe systemic disease
- complete medication list
- patient information, consent and aftercare
- IFU, SOP and hygiene requirements
A complete blood count including platelet count may be useful depending on the patient situation. If the history is suspicious, further parameters such as INR, aPTT or specialist assessment may be required.
State of research
The scientific literature on PRP is extensive but heterogeneous. Studies often differ in indication, patient group, preparation, platelet concentration, leukocyte content, activation, application route and endpoints. Claims about PRP should therefore be indication-specific, source-critical and cautious.
PRP tubes and material selection
Suitable tubes, centrifuges and sterile consumables are needed for PRP preparation. Material selection should be based on the planned application, practice SOP, manufacturer instructions and hygiene requirements. Medical professionals can find an overview in the PRP tubes category. Technical information on Vi PRP-PRO PRP tubes should always be considered together with the relevant instructions for use and the intended workflow.
Neutral material note for medical professionals
The choice of a tube or system does not replace indication, medical risk assessment or proper application. No treatment outcome can be derived from product information.
Frequently asked questions
Is PRP suitable for everyone?
No. Contraindications, medication, infection status, blood values, comorbidities and the concrete indication must be medically assessed beforehand.
Can painkillers be taken before PRP?
That depends on the active substance, dose, indication and underlying disease. NSAIDs may influence platelet function. The treating physician decides.
Is PRP suitable during pregnancy or breastfeeding?
For many PRP applications robust data are limited. Non-medically necessary aesthetic applications should generally be postponed.
Is PRP allowed in cancer patients?
Active cancer requires particular caution. In patients with a cancer history, an individual decision and oncological consultation may be appropriate.
Are PRP tubes decisive for the outcome?
PRP tubes are part of the preparation process. Centrifuge, RCF/g value, centrifugation time, protocol, hygiene and professional application are also relevant.
Conclusion
PRP is used and investigated in different medical fields, but it is not suitable for every patient. Contraindications, comorbidities, medication, laboratory values and clinical condition must be checked carefully before application. Where uncertainty remains, PRP should be postponed or clarified with a specialist.
Compliance: This article does not constitute a therapy recommendation, medical advice or a promise of specific treatment outcomes. The decision on indication, performance, material selection and aftercare lies with the treating physician. Manufacturer instructions, instructions for use, SOPs and applicable legal requirements must be observed.
Sources and further reading
- German Heilmittelwerbegesetz, § 3 misleading advertising: https://www.gesetze-im-internet.de/heilmwerbg/__3.html
- Eymard F. et al. PRP contraindications in infectious, oncological and haematological comorbidities: https://pubmed.ncbi.nlm.nih.gov/40260684/
- Lim J. J. et al. Reporting of PRP preparation and composition: https://pubmed.ncbi.nlm.nih.gov/38522650/
- Kon E. et al. Universal consensus on platelet-rich plasma: https://pubmed.ncbi.nlm.nih.gov/39073848/
