Frey Christopher, Yeh Peter Chia, Jayaram Prathap
Baylor College of Medicine, Houston, Texas, USA.
H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.
Orthop J Sports Med. 2020 Apr 29;8(4):2325967120912841. doi: 10.1177/2325967120912841. eCollection 2020 Apr.
Platelet-rich plasma (PRP) has wide applications in orthopaedic care. Its beneficial effects are attributed to the growth factor profile from the platelet secretome. In theory, these effects would be diminished by medications that inhibit platelet activation and/or the subsequent release of growth factors.
To determine whether commonly used antiplatelets, nonsteroidal anti-inflammatory drugs (NSAIDs), or anticoagulant medications affect platelet growth factor release in PRP.
Systematic review; Level of evidence, 2.
A systematic review of the literature related to antiplatelet, anti-inflammatory, and anticoagulant drugs was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We used the Downs and Black objective quality scoring system. The literature search consisted of PubMed and Cochrane Library databases. Search terms consisted of 1 item selected from "platelet-rich plasma," "platelet-derived growth factor," and "platelet-rich plasma AND growth factor" combined with 1 item from "antiplatelet," "aspirin," "anticoagulant," and "NSAID." Only studies published within the past 25 years were included.
A total of 15 studies met the inclusion criteria: 7 studies detected no significant decrease in growth factors or mitogenesis, whereas 6 detected a decrease with antiplatelet agents, 1 detected mixed results with an antiplatelet agent, and 1 had mixed results with an antiplatelet agent/vasodilator. In terms of PRP activation, all 3 studies assessing collagen, the 2 studies analyzing adenosine diphosphate alone, and the 1 study investigating arachidonic acid found a decrease in growth factor concentration.
Antiplatelet medications may decrease the growth factor release profile in a cyclooxygenase 1- and cyclooxygenase 2-dependent manner. Eight of 15 studies found a decrease in growth factors or mitogenesis. However, more studies are needed to comprehensively understand antiplatelet effects on the PRP secretome.
富血小板血浆（PRP）在骨科治疗中有着广泛应用。其有益作用归因于血小板分泌产物中的生长因子谱。理论上，抑制血小板活化和/或后续生长因子释放的药物会减弱这些作用。
确定常用的抗血小板药物、非甾体抗炎药（NSAIDs）或抗凝药物是否会影响PRP中血小板生长因子的释放。
系统评价；证据等级，2级。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，对与抗血小板、抗炎和抗凝药物相关的文献进行系统评价。我们使用了唐斯和布莱克客观质量评分系统。文献检索包括PubMed和Cochrane图书馆数据库。检索词由从“富血小板血浆”“血小板衍生生长因子”和“富血小板血浆与生长因子”中选出的1项，与从“抗血小板”“阿司匹林”“抗凝剂”和“NSAID”中选出的1项组合而成。仅纳入过去25年内发表的研究。
共有15项研究符合纳入标准：7项研究未检测到生长因子或有丝分裂发生显著降低，而6项研究检测到抗血小板药物使其降低，1项研究检测到一种抗血小板药物的结果混合，1项研究检测到一种抗血小板药物/血管扩张剂的结果混合。就PRP活化而言，所有3项评估胶原蛋白的研究、2项单独分析二磷酸腺苷的研究以及1项研究花生四烯酸的研究均发现生长因子浓度降低。
抗血小板药物可能以环氧化酶1和环氧化酶2依赖的方式降低生长因子释放谱。15项研究中有8项发现生长因子或有丝分裂发生降低。然而，需要更多研究来全面了解抗血小板药物对PRP分泌产物的影响。
