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PRP & Platelet Gel A Review by P. Everts & Others 2006

March 5, 2010

PRP & Platelet Gel A Review by P. Everts & Others 2006INTRODUCTION

Few hospitals in Europe routinely use autologous platelet gel application techniques as part of a peri-operative blood management program. In the United States, an increasing number of clinicians tend to employ platelet gel applications in various surgical settings, for both in, and out of hospital surgery. The question why this novel and promising technique for the delivery of autologous growth factors has not yet been adopted on a broader scale need to be addressed. The main reason may be the lack of convincing scientific data that provides information whether or not the use of platelet rich plasma (PRP) and platelet gels (PG) are appropriate in the clinical setting. At the Catharina Hospital in Eindhoven The Netherlands, we started to utilize PG techniques in 2001 with a small group of patients undergoing complicated cardiac surgical procedures and in patients undergoing a spinal fusion operation. This was carried out as an adjunct to the already existing perioperative blood management programs with apparently impressive clinical results.

The Department of Peri-operative Blood Management of the Catharina Hospital performs close to 1600 blood management procedures annually, of which 60% are related to obtain whole blood platelets to produce PRP for the utilization of PG procedures. While it’s extended use is based upon positive clinical impressions and on clinical judgment, it still lacks a firm scientific basis. Therefore, clinical trials are required to answer questions on the efficacy, efficiency, and on the safety of PG applications under various surgical and medical conditions.

It is clear that a good understanding of the proper preparation and utilization of this specific blood management technique is mandatory for clinicians to adequately evaluate results of its use and to avoid inconsistent results. Conflicting data have been reported in clinical and experimental research on the efficacy of PG treatment1-5. To understand how this arises it is essential to be in possession of the details of the preparation of PRP and PG. Knowledge of the following factors are of particular importance: the method of drawing blood, the quality of the PRP used, platelet and growth factor counts, the PRP activation, whether autologous or donor PRP was used, and the overall methodology. With respect to these issues, the clinician should be aware that data may sometimes appear to be conflicting in the eventual outcome.

This review addresses a variety of aspects pertaining to the use of PG; these include background on platelet activity, the pivotal role of platelets in hemostasis, soft tissue healing and bone growth, the whole blood PRP production procedure, Platelet rich plasma and platelet gel. A review platelet activation with thrombin, and a description of the various actions of platelet derived growth factors. In addition, a discussion of the most recent clinical and experimental articles is presented with respect to these issues. Some safety issues including possible PG mitogenic effects are also addressed.

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