What effect do anticoagulants have?

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Role of the anticoagulant in PRP Therapy

In PRP therapy, anticoagulants such as citrate or ACD-A are added to blood samples to prevent clotting during preparation, ensuring that platelets remain viable and functional for growth factor release 1,5,7. By chelating calcium and stabilizing the sample, these agents help maintain platelet integrity and allow for effective separation and concentration of platelets used in regenerative treatments 1,5.

Platelet Yield and Function

  • Sodium Citrate (SC): Preserves platelet morphology and function, leading to high platelet recovery and optimal growth factor release.
  • Acid Citrate Dextrose (ACD-A): While ACD-A may yield fewer platelets than EDTA, its ability to maintain platelet functionality and growth factor potency makes it the gold standard for clinical PRP therapy. Buffering post-preparation is essential to neutralize acidity and maximize therapeutic benefits 1,5
  • EDTA: Strong chelator, yields high platelet counts but can alter platelet shape and reduce biological efficacy.
  • Heparin: Can cause platelet aggregation and inaccurate counts; should not be used in modern PRP systems.

ACD-A vs. SC

  • Composition: Sodium citrate is a single compound (trisodium citrate), while ACD-A is a solution containing sodium citrate, citric acid, and dextrose in specific proportions 3,6.
  • Anticoagulant Action: Both prevent clotting by chelating calcium in the blood, but ACD-A's additional components (citric acid and dextrose) help preserve platelet function and viability more effectively during PRP preparation 3,4.
  • Clinical Preference: ACD-A is considered the gold standard and is FDA-approved for PRP because it better maintains platelet integrity and growth factor release compared to sodium citrate alone 1,3,4.
  • Patient Experience: Some studies note that PRP prepared with sodium citrate may cause less discomfort during injection compared to ACD-A, but ACD-A remains preferred for optimal platelet preservation and clinical outcomes 2,3.

Growth Factor Release

  • SC: Maximizes growth factor and cytokine release from activated platelets.
  • ACD: Acceptable if calcium is replaced before use; otherwise, growth factor release may be suboptimal.
  • EDTA/Heparin: Impairs growth factor release and may alter cytokine profiles.

Inflammatory and Healing Response

  • SC: Low inflammatory risk, supports MSC proliferation and tissue healing.
  • ACD: May delay healing or cause minor inflammatory papules in some patients.
  • EDTA/Heparin: Not recommended for regenerative medicine due to negative effects on platelet function and higher contamination risk.
  • ACD-A: May induce inflammatory response.

Common PRP Systems: Anticoagulant Use and Clinical Implications

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PRP system

Anticoagulant


Juventix

ACD-A

Arthrex Angel

ACD-A

Emcyte

Sodium Citrate

Regen

Sodium Citrate

Cellenis

MNC7

Harvest

ACD-A

Dr. PRP

ACD-A

Integrity

ACD-A

Progen

ACD-A

Apex Xcell

ACD-A

CARE stream

ACD-A

Selphyl

Sodium Citrate

EZ Gel

none


Summary

The type and amount of anticoagulant in a PRP system directly affect platelet yield, growth factor release, and clinical outcomes. Juventix and most leading competitors use ACD-A for optimal efficacy and safety, while systems using ACD may require additional steps to achieve similar results. Avoid EDTA and heparin for regenerative purposes.

 

Based on the most recent and relevant sources, there is a list of vendors below that offer PRP tubes or systems with EDTA and/or heparin as anticoagulants. It is important to note that while these anticoagulants are available, their use in clinical PRP therapy is generally discouraged due to negative effects on platelet function and regenerative efficacy. Most clinical PRP systems use sodium citrate, ACD-A, or ACD instead. Vendors below may serve research, laboratory, or veterinary markets, and not all are intended for human regenerative medicine.

Vendors—including ZenBio, HBH Medical, Siny Medical, YBO Medical, PRPmed.de, and IPPOCARE—offer PRP tubes with EDTA and/or heparin. DO NOT USE THESE

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