Abstract
Background and Aim
Platelet-rich plasma (PRP) has long been used in skin rejuvenation and hair loss treatment. Some patients require multiple intradermal injections into the face and scalp, and the way in which these patients process and experience pain differs, depending on the patient. Minimizing pain and discomfort during nonsurgical procedures is essential for patient satisfaction. In our experience, the use of acid citrate dextrose-A (ACD-A) as an anticoagulant caused more patient discomfort than did sodium citrate (Na-citrate) among patients who underwent facial rejuvenation with PRP. The aim of the present study was to evaluate patient-related discomfort in PRP sessions using two different anticoagulants.
Materials and Methods
This clinical trial included 10 patients who received facial PRP injections for facial rejuvenation and 10 patients who received PRP injections in their scalps for hair loss. On the application area, half the surface was treated with Na-citrate PRP injections, and the other half was treated with the same amount of ACD-A PRP injections. Neither the doctors who applied the treatment nor the patients were given information about which anticoagulant was used in each area. Immediately after the procedure, the patients were asked to score their pain on each side of the application area on a scale of 1–10 using a visual analog scale (VAS).
Results
PRP injections using Na-citrate as an anticoagulant caused less discomfort on both the face and scalp as compared with that of ACD-A. The outcome was statistically significant.
Conclusion
Anticoagulants used in PRP preparation affected patients’ pain perceptions during the injections. The sensation of pain with PRP prepared with Na-citrate as an anticoagulant was lower than that of PRP prepared with ACD-A. Further studies are required to evaluate the correlation between anticoagulants used for PRP preparation and pain feelings during injections.
Level of Evidence III
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References
Dhurat R, Sukesh M (2014) Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesthet Surg 7(4):189–197. https://doi.org/10.4103/0974-2077.150734
Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62(4):489–496
Russell RP, Apostolakos J, Hirose T et al (2013) Variability of platelet-rich plasma preparations. Sports Med Arthrosc Rev 21(4):186–190. https://doi.org/10.1097/JSA.0000000000000007
Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009) Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 27(3):158–167. https://doi.org/10.1016/j.tibtech.2008.11.009
Anitua E (1999) Plasma rich in growth factors: preliminary results of use in the preparation of future sites for implants. Int J Oral Maxillofac Implants 14(4):529–535
Fouché JJ, Van Loghem JAJ, Thuis J, De Heer LM, van Oijen MGH (2017) Left/right pain asymmetry with injectable cosmetic treatments for the face. Aesthet Surg J 37(6):708–714. https://doi.org/10.1093/asj/sjw214
Taddio A, Ilersich AL, Ipp M, Kikuta A, Shah V, HELPinKIDS Team (2009) Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin Ther 31(Suppl 2):S48–S76. https://doi.org/10.1016/j.clinthera.2009.07.024
Sezgin B, Ozel B, Bulam H, Guney K, Tuncer S, Cenetoglu S (2014) The effect of microneedle thickness on pain during minimally invasive facial procedures: a clinical study. Aesthet Surg J 34(5):757–765. https://doi.org/10.1177/1090820X14532941
Lei H, Gui L, Xiao R (2009) The effect of anticoagulants on the quality and biological efficacy of platelet-rich plasma. Clin Biochem 42(13–14):1452–1460. https://doi.org/10.1016/j.clinbiochem.2009.06.012
Xian LJ, Chowdhury SR, Bin Saim A, Idrus RB (2015) Concentration-dependent effect of platelet-rich plasma on keratinocyte and fibroblast wound healing. Cytotherapy 17(3):293–300. https://doi.org/10.1016/j.jcyt.2014.10.005
Choi BH, Zhu SJ, Kim BY et al (2005) Effect of platelet-rich plasma (PRP) concentration on the viability and proliferation of alveolar bone cells: an in vitro study. Int J Oral Maxillofac Surg 34:420–424
Graziani F, Ivanovski S, Cei S, Ducci F, Tonetti M, Gabriele M (2006) The in vitro effect of different PRP concentrations on osteoblasts and fibroblasts. Clin Oral Implants Res 17(2):212–219
Yoshida R, Cheng M, Murray MM (2014) Increasing platelet concentration in platelet-rich plasma inhibits anterior cruciate ligament cell function in three-dimensional culture. J Orthop Res 32(2):291–295. https://doi.org/10.1002/jor.22493
Arora S, Doda V, Kotwal U et al (2016) Quantification of platelets and platelet derived growth factors from platelet-rich-plasma (PRP) prepared at different centrifugal force (g) and time. Transfus Apher Sci 54(1):103–110. https://doi.org/10.1016/j.transci.2016.01.028
Franco D, Franco T, Schettino AM et al (2012) Protocol for obtaining platelet-rich plasma (PRP), platelet-poor plasma (PPP), and thrombin for autologous use. Aesthetic Plast Surg 36(5):1254–1259. https://doi.org/10.1007/s00266-012-9957-3
Araki J, Jona M, Eto H et al (2012) Optimized preparation method of platelet-concentrated plasma and noncoagulating platelet-derived factor concentrates: maximization of platelet concentration and removal of fibrinogen. Tissue Eng C Methods 18(3):176–185. https://doi.org/10.1089/ten.TEC.2011.0308
Perez AG, Lana JF, Rodrigues AA et al (2014) Relevant aspects of centrifugation step in the preparation of platelet-rich plasma. ISRN Hematol 25(2014):176060. https://doi.org/10.1155/2014/176060
Kobayashi E, Flückiger L, Fujioka-Kobayashi M, Sawada K, Sculean A, Schaller B, Miron RJ (2016) Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clin Oral Investig 20(9):2353–2360. https://doi.org/10.1007/s00784-016-1719-1
Mazzucco L, Balbo V, Cattana E, Guaschino R, Borzini P (2009) Not every PRP-gel is born equal. Evaluation of growth factor availability for tissues through four PRP-gel preparations: Fibrinet, RegenPRP-Kit, Plateltex and one manual procedure. Vox Sang 97(2):110–118. https://doi.org/10.1111/j.1423-04https://doi.org/10.2009.01188.x
Lippi G, Salvagno GL, Montagnana M, Poli G, Guidi GC (2006) Influence of the needle bore size on platelet count and routine coagulation testing. Blood Coagul Fibrinolysis 17(7):557–561
Sclafani AP, Azzi J (2015) Platelet preparations for use in facial rejuvenation and wound healing: a critical review of current literature. Aesthet Plast Surg 39(4):495–505. https://doi.org/10.1007/s00266-015-0504-x
Foster TE, Puskas BL, Mandelbaum BR et al (2009) Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 37(11):2259–2272. https://doi.org/10.1177/0363546509349921
Bausset O, Giraudo L, Veran J et al (2012) Formulation and storage of platelet-rich plasma homemade product. Biores Open Access 1(3):115–123. https://doi.org/10.1089/biores.2012.0225
Singh S (2018) Comparative (quantitative and qualitative) analysis of three different reagents for preparation of platelet-rich plasma for hair rejuvenation. J Cutan Aesthet Surg 11(3):127–131. https://doi.org/10.4103/JCAS.JCAS_108_18
Giraldo CE, Álvarez ME, Carmona JU (2015) Effects of sodium citrate and acid citrate dextrose solutions on cell counts and growth factor release from equine pure-platelet rich plasma and pure-platelet rich gel. BMC Vet Res 14(11):60. https://doi.org/10.1186/s12917-015-0370-4
Callan MB, Shofer FS, Catalfamo JL (2009) Effects of anticoagulant on pH, ionized calcium concentration, and agonist-induced platelet aggregation in canine platelet-rich plasma. Am J Vet Res 70(4):472–477. https://doi.org/10.2460/ajvr.70.4.472
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Görgü, M., Gökkaya, A. & Doğan, A. Comparison of Two Anticoagulants for Pain Associated with Platelet-Rich Plasma Injections. Aesth Plast Surg 44, 955–961 (2020). https://doi.org/10.1007/s00266-019-01541-z
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DOI: https://doi.org/10.1007/s00266-019-01541-z