Starting PRP (Platelet Rich Plasma) for your Joints? You should keep this in mind if you consume NSAIDs (Non-Steroidal Anti-inflammatories)

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Prajakta Shendge

Jan 15, 2021

PRP

There was a period when doctors used NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) to decrease the risk of heart attack and aspirin was the go-to NSAID. In comparison, however, researchers in Montreal reported in 2017 that the existing use of NSAIDs substantially increased the risk of a heart attack. Hence there are some questions still unanswered; Is the use of NSAIDs a good idea, especially if you are planning a treatment with platelet-rich plasma (PRP)? Is the PRP mechanism not affected by NSAIDs? Many research studies have proved otherwise.

What is this novel PRP treatment?

Platelet-rich plasma is used for treating a variety of conditions, from orthopaedic joint problems to hair loss. It has emerged as a successful alternative to surgery, which is encouraging. PRP is processed by extracting platelets from your blood that are rich in blood growth factors, such as platelet growth factor (PDGF), growth factor beta transformation (TGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), growth factor fibroblast (FGF), and connective tissue growth factor. When the doctor injects these condensed platelets into the injured tissue, to stimulate natural healing, they slowly release the growth factors. However, the efficiency and natural healing of the PRP can impact what you take as far as daily medications are concerned.

What is Aspirin and NSAIDs?

While NSAIDs are effective painkillers, by inhibiting cyclooxygenase (COX) enzymes, they inhibit platelet activation and accumulation. Consequently, this inhibition will accelerate the bleeding time and the growth factors will not be secreted by platelets. Due to this compromised platelet activation, while receiving PRP treatment, patients consuming NSAIDs will not have any therapeutic benefit.

Is it safe to use NSAIDs and aspirin? Some research indicates that if you are planning a PRP treatment, it’s probably not. Let’s find out why?
In PRP therapy, what is the function of NSAIDs?

While NSAIDs are effective painkillers, by inhibiting cyclooxygenase (COX) enzymes, they inhibit platelet activation and accumulation. Consequently, this inhibition will accelerate the bleeding time and the growth factors will not be secreted by platelets. Due to this compromised platelet activation, while receiving PRP treatment, patients consuming NSAIDs will not have any therapeutic benefit.

There is however a distinction between the influence on the platelets of aspirin and non-aspirin NSAIDs. Aspirin inhibits cyclooxygenase enzymes irreversibly; its activities thus continue (about 8-10 days) for the lifetime of the circulating platelets. Where cyclooxygenase enzymes are reversibly inhibited by non-aspirin NSAIDs and thus the degree of their activity depends on the appropriate drug dosage, half-life and serum level. By discontinuing the consumption of NSAIDs, in particular Naproxen, for a minimum of one week before PRP treatment, it may improve the secretion of biological growth factors as PRP is meant to. 4

So, if you are taking NSAIDs and have a PRP treatment planned. It means that your use of NSAIDs, especially aspirin, could disrupt your PRP procedure, leading to results that are less satisfactory than they would otherwise be.

How long will the impact of NSAIDs last?

The effect of NSAIDs and aspirin takes about ten days to wear off. Therefore you can avoid NSAIDs two weeks before the PRP procedure in order to be on the safe side. Additionally, because growth factors are released by the injected platelets for about two weeks, you should also keep off from the NSAIDs after the PRP procedure. However before stopping any drug, always speak to your doctor!

In summary

It is best to temporarily suspend NSAIDs two weeks before and after the PRP treatment to get the best possible outcomes of the procedure. After a thorough talk with your orthopaedic consultant, please follow the instructions above.

For more information and advice do feel free to contact our team of regenerative expert scientists and clinicians.

 

References:
  1. M. Bally, N.Dendukuri, B. Rich,L. Nadeau, A.Helin-Salmivaara, E.Garbe, J. M. Brophy. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017;357:j1909
  2. G. Schippinger, F. Prüller, M. Divjak, E. Mahla, F. Fankhauser, S. Rackemann, R.BerndRaggam.Autologous Platelet-Rich Plasma Preparations: Influence of Nonsteroidal Anti-inflammatory Drugs on Platelet Function.Orthop J Sports Med. 2015 Jun 23;3(6):2325967115588896.
  3. A. I. Schafer.Effects of NonsteroidalAntiinflammatoryDrugs on Platelet Function and Systemic Hemostasis. J Clln Pharmacol1995;35:209-219.
  4. S. Mannava, M.D., Ph.D., K. E. Whitney, B.S., M. I. Kennedy, B.S., J. l. King, B.S., G. J. Dornan, M.S., K. Klett, B.S., J.Chahla, M.D., Ph.D., T. A. Evans, M.D., J. Huard, Ph.D., R. F. LaPrade, M.D., Ph.D.The Influence of Naproxen on Biological Factors in Leukocyte-Rich Platelet-Rich Plasma: A Prospective Comparative Study. Arthroscopy 2019; VOL. 35, ISSUE 1, P201-210

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