A Systematic Review on the Effect of Common Medications on Platelet Count and Function: Which Medications Should Be Stopped Before Getting a Platelet-Rich Plasma Injection?
Kao DS, Zhang SW, Vap AR. Orthop J Sports Med. 2022 Apr 12;10(4):23259671221088820. doi: 10.1177/23259671221088820.
Aspirin, acetaminophen, and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) may inhibit platelet function. Providers should ask a patient to suspend these medications before a platelet-rich plasma (PRP) injection.
Platelet-rich plasma (PRP) injections contain a patient’s platelets in a small volume of plasma. Clinicians may use PRP to treat various soft tissue injuries and promote healing following certain surgical procedures. The platelets release growth factors and cytokines to encourage a healing response. Although investigators have examined the optimal platelet concentrations and preparation methods, little research exists on how patient-specific factors impact PRP efficacy.
Kao and colleagues conducted a systematic review to evaluate how common medications affect platelets. The researchers then established guidelines for medications a patient should stop before a PRP injection.
An initial database search yielded 1,711 articles, and 20 articles met all inclusion criteria. Of these 20 studies, 15 were randomized controlled trials, and 5 were cohort studies. Inclusion criteria required that a paper reported on platelet function and at least one common medication (aspirin, acetaminophen, nonselective NSAID, cyclooxygenase 2-selective NSAID, a statin, or gabapentin). Several outcomes for platelet function were assessed, including platelet count, platelet aggregation, and platelet adhesion. No studies with gabapentin met all inclusion criteria.
A total of 792 people (387 male, 194 female, and 211 unspecified) participated in the 20 studies. The age range of the participants was 18 to 88 years old. Furthermore, 449 participants were considered healthy, and 343 reported a chronic condition or history of surgery. Patients taking aspirin, acetaminophen, or nonselective NSAIDs (such as ibuprofen) demonstrated decreased platelet aggregation. Statins and COX-2 selective NSAIDs did not affect platelet aggregation. Aspirin, statins, and NSAIDs had little or no impact on platelet count.
PRP is an effective treatment for many soft tissue injuries. Patient-specific factors, such as medication use, may impact PRP efficacy. These results indicate that providers should suspend aspirin, acetaminophen, and nonselective NSAIDs before a PRP injection. However, if potential risks related to medication suspension exist, patients and clinicians should discuss these risks. This discussion is especially relevant since the authors could only determine if the medications impacted platelets and not if they affected the overall efficacy of PRP.
If reasonable, clinicians should advise patients to suspend specific medications before a PRP injection to help improve the efficacy of the treatment.
Questions for Discussion
In your clinical experience, do you or your consulting physician recommend suspending certain medications before a PRP injection? If so, have you noticed a difference in the efficacy of the treatment?
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Written by Rebecca Rodriguez
Reviewed by Jeffrey Driban
In my clinical experience, we usually have not had our patients stop taking Tylenol- and NSAID-like medications prior to their PRP injection. I have not seen it explicitly stated that they should stop taking these medications, but most are already not taking them due to them being not helpful in the past. We have followed the research and had the patients stop medications after the PRP injections, but I would be interested to see if taking any medication before would have an effect on the benefits of the PRP. Could the possible analgesic effects influence the PRP injection if it was taken 24 hours prior to the injection or does it only affect the PRP injection if it was taken after?