Ramsook Ryan Ravi, Danesh Houman
Department of Rehabilitation Medicine and Department of Anesthesiology at Icahn School of Medicine at Mount Sinai.
Pain Physician. 2016 Sep-Oct;19(7):E1055-61.
The use of platelet rich plasma (PRP) spans across many fields owing to its role in healing and as a natural alternative to surgery. PRP continues to grow however much of the literature is anecdotal or case report based and there is a lack of controlled trials to evaluate standards for PRP. The International Cellular Medical Society (ICMS) has developed guidelines to help with the safe advancement of PRP; however there remains a gap in literature concerning the timing of PRP injections in patients who are on antithrombotic therapy. The importance of an intact platelet surface membrane allows for the appropriate release of the healing bioproteins and growth factors granting PRP therapy its efficacy. This along with the proliferation of differentiated cells, enhancement of collagen synthesis, early angiogenesis and revascularization help promote the benefits of regeneration. The intrinsic and extrinsic pathways of the coagulation cascade are valuable in that disruption of this mechanism or prematurely activated platelets may result in limited efficacy. Anticoagulants and antiplatelet drugs are commonly used in patients who are candidates for PRP. As antithrombotic agents affect platelet stability, they will have an effect on PRP efficacy and must be discontinued at an appropriate time frame prior to injection therapy. Understanding the pharmacokinetics and platelet effects can help guide discussion on the proper timing of discontinuation and resumption of a particular antithrombotic agent. With future research, the establishment of clinical practice guidelines concerning PRP and antithrombotic therapy can help structure safe and efficacious means in which to promote healing and regeneration in a growing patient population. Platelet rich plasma, antithrombotic therapy, coagulation, platelet activation, regenerative medicine, growth factors.
富血小板血浆（PRP）因其在愈合过程中的作用以及作为手术的天然替代方法，在许多领域都有应用。然而，PRP的应用仍在不断发展，不过许多文献都是基于轶事或病例报告，缺乏评估PRP标准的对照试验。国际细胞医学协会（ICMS）已制定指南以帮助安全推进PRP的应用；然而，关于接受抗血栓治疗患者的PRP注射时机，文献中仍存在空白。完整的血小板表面膜很重要，它能使愈合生物蛋白和生长因子适当释放，从而赋予PRP治疗效果。这与分化细胞的增殖、胶原蛋白合成的增强、早期血管生成和血管再形成一起，有助于促进再生益处。凝血级联反应的内源性和外源性途径很重要，因为该机制的破坏或血小板过早激活可能导致疗效受限。抗凝血剂和抗血小板药物常用于PRP治疗的候选患者。由于抗血栓药物会影响血小板稳定性，它们会对PRP疗效产生影响，必须在注射治疗前的适当时间停药。了解药代动力学和血小板效应有助于指导关于特定抗血栓药物停药和重新开始使用的正确时机的讨论。随着未来的研究，建立关于PRP和抗血栓治疗的临床实践指南有助于构建安全有效的方法，以促进不断增长的患者群体的愈合和再生。富血小板血浆、抗血栓治疗、凝血、血小板激活、再生医学、生长因子。
