Finding evidence of efficacy and safety of autologous platelet-rich plasma in treating chronic wounds: systematic review

Cilj: Pronaći najnovije dostupne dokaze o djelotvornosti i sigurnosti autologne plazme bogate trombocitima u liječenju kroničnih rana. Materijali i metode: Osnovu ovog istraživanja čini Cochrane sustavni pregled pod nazivom „Autologous platelet-rich plasma for treating chronic wounds (Review)“. Provedeno je pretraživanje baza podataka MEDLINE i CENTRAL kako bismo identificirali najnovije randomizirane kontrolirane studije i nedavne sustavne preglede, objavljene nakon zadnje pretrage literature spomenutog Cochrane sustavnog pregleda. Kvaliteta ovog Cochrane sustavnog pregleda, kao i svih ostalih obrađenih sustavnih pregleda, procijenjena je putem AMSTAR-2 obrasca za ocjenu kvalitete. Rezultati: Uz Cochrane sustavni pregled, identificirano je još 7 randomiziranih kontroliranih ispitivanja i 4 sustavna pregleda sa provedenom meta analizom. U analizi rezultata tri istraživanja provedena na dijabetičkom ulkusu stopala, pokazano je poboljšanje procesa zacjeljivanja ulkusa u skupini pacijenata koji su primali terapiju autolognog PRP. Tri ispitivanja usmjerena na venske ulkuse, pružila su dokaze o smanjenju veličine ulkusa i ubrzanju vremena potrebnog za njihovo zacjeljivanje u grupi tretiranoj PRP-om. Također, jedno ispitivanje na dekubitusima pokazalo je sličan pozitivan učinak, sa smanjenjem veličine ulkusa u grupi koja je primila tretman PRP-a. Meta analize sva četiri sustavna pregleda sugeriraju pozitivan učinak PRP-a na proces cijeljenja rana. Posebno, jedan od sustavnih pregleda je, osim povećane stope zacjeljenja rane, istaknuo i značajno smanjenje stope amputacija u PRP skupini, u kontekstu liječenja dijabetičkih ulkusa stopala. Drugi sustavni pregled pak naglašava da je pozitivan učinak PRP-a najizraženiji u kontekstu venskih ulkusa, dok za druge vrste ulkusa rezultati nisu bili jednako uvjerljivi. Zaključak: PRP pokazuje potencijalno pozitivan učinak u procesu cijeljenja rana, no za ojačanje pouzdanosti ovih nalaza potrebna su daljnja opsežnija istraživanja i precizna standardizacija protokola pripreme i primjene PRP-a.Objectives: To find the latest available evidence regarding the efficacy and safety of autologous platelet-rich plasma (PRP) in treating chronic wounds. Materials and methods: This study is based on the Cochrane systematic review titled "Autologous Platelet-Rich Plasma for Treating Chronic Wounds (Review)". Search of the MEDLINE and CENTRAL databases was conducted to identify the most recent randomized controlled trials and recent systematic reviews published after the last literature search of the mentioned Cochrane systematic review. The quality of this Cochrane systematic review, as well as all other processed systematic reviews, was assessed using the AMSTAR-2 tool for quality assessment. Results: In addition to the Cochrane systematic review, we identified seven randomized controlled trials and four systematic reviews with meta-analyses. The analysis of the results from three studies conducted on diabetic foot ulcers demonstrated an improvement in the wound healing process in the group of patients receiving autologous PRP therapy. Three studies focused on venous ulcers provided evidence of reduced ulcer size and accelerated healing time in the group treated with PRP. Moreover, one study on pressure ulcers showed a similar positive effect, with a reduction in ulcer size in the PRP-treated group. Meta-analyses from all four systematic reviews suggest a positive effect of PRP on the wound healing process. Specifically, one of the systematic reviews not only highlighted an increased rate of wound healing but also a significant reduction in amputation rates in the PRP group, particularly in the context of diabetic foot ulcer treatment. Another systematic review emphasized that the positive effect of PRP was most most notably noticed in relation to venous ulcers, while the results for other types of ulcers were not equally convincing. Conclusion: PRP demonstrates potential positive effects on the wound healing process. However, further extensive research and precise standardization of PRP preparation and application protocols are needed to strengthen the reliability of these findings