Clinical Studies on Platelet-Rich Plasma Therapy for Chronic Cutaneous Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Shanqiang Qu, Zhicheng Hu, Yi Zhang, Peng Wang, Shuting Li, Shaobin Huang, Yunxian Dong, Hailin Xu, Yanchao Rong, Wenkai Zhu, Bing Tang, Jiayuan Zhu, Shanqiang Qu, Zhicheng Hu, Yi Zhang, Peng Wang, Shuting Li, Shaobin Huang, Yunxian Dong, Hailin Xu, Yanchao Rong, Wenkai Zhu, Bing Tang, Jiayuan Zhu

Abstract

Significance: Platelet-rich plasma (PRP) may be a potential drug for treatment of chronic refractory ulcers, which increase the risk of systemic infection and local canceration. However, the efficacy and safety of clinical application of PRP are still controversial. Thus, this study was aimed to assess the efficacy and safety of PRP in patients with chronic ulcers. Recent Advances: For this meta-analysis, Cochrane's Library, MEDLINE, EMBASE, PubMed, Web of Science, and CINAHL (Cumulate Index to Nursing and Allied Health Literature) databases were searched. Results were pooled using a random-effects model. The primary outcome was the proportion of completely healed chronic ulcers. Critical Issues: Seventeen randomized controlled trials were included. Compared with the control group, PRP significantly increased the fraction of healed ulcers (pooled risk ratio [RR] = 1.50; 95% confidence interval [CI] = 1.20 to 1.87; I2 = 47.8%). In autologous PRP (APRP) and homologous PRP (HPRP) subgroups, there were statistical differences between the control group versus treatment subgroup (pooled RR = 1.30, 95% CI = 1.10 to 1.54, I2 = 25.7%; pooled RR = 3.53, 95% CI = 1.94 to 6.43, I2 = 0.0%, respectively). In terms of percent of chronic ulcers area healed, there was a statistically significant difference between the PRP-treated group versus the control group (standard mean difference [SMD] = 1.37, 95% CI = 0.91 to 1.82, I2 = 22.1%). As for PRP safety, there existed a statistically significant difference between the APRP subgroup and the HPRP subgroup, respectively (pooled RR = 0.58; 95% CI = 0.35 to 0.98; I2 = 0.0%) and (pooled RR = 4.12; 95% CI = 1.55 to 10.96; I2 = 6.8%). Future Directions: Our findings shows that PRP may be a beneficial treatment of chronic skin ulcers and that APRP may be much safer than HPRP.

Keywords: chronic cutaneous ulcers; meta-analysis; platelet-rich plasma; wound healing.

Conflict of interest statement

No competing financial interests exist.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9831249/bin/wound.2020.1186_figure9.jpg
Jiayuan Zhu, MD, PhD
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9831249/bin/wound.2020.1186_figure10.jpg
Bing Tang, MD, PhD
Figure 1.
Figure 1.
The flow diagram of the literature search process.
Figure 2.
Figure 2.
(A) Forest plot of the meta-analysis of the proportions of completely healed chronic cutaneous ulcers in patients allocated to the PRP group and the control group, respectively. (B) Subgroup analysis of the proportions of completely healed chronic cutaneous ulcers in patients allocated to the PRP group and the control group according to the type of PRP used. PRP, platelet-rich plasma.
Figure 3.
Figure 3.
Sensitivity analysis of the proportions of completely healed chronic cutaneous ulcers in patients allocated to the PRP group and the control group. Color images are available online.
Figure 4.
Figure 4.
Funnel plots of the publication bias of each subgroup (autologous PRP, A; homologous PRP, B) and of publication bias of the pooled included trials (C). Color images are available online.
Figure 5.
Figure 5.
TSA of the presently included studies. A two-sided graph is plotted by TSA where the blue etched lines represent conventional significance boundaries, the blue line indicates the cumulative Z-score, and the red lines show the α-spending boundary and the required information size. TSA, trial sequential analysis. Color images are available online.
Figure 6.
Figure 6.
Forest plot for the meta-analyses of the secondary outcomes: percentage area healed of the chronic cutaneous ulcers. Color images are available online.
Figure 7.
Figure 7.
Forest plot for the meta-analyses of the secondary outcomes: Total epithelium-covered area of chronic cutaneous ulcers. Color images are available online.
Figure 8.
Figure 8.
(A) Forest plot for meta-analysis of the adverse effects related to the therapies in patients allocated to the PRP group and the control group. (B) Subgroup analysis of the adverse effects related to the therapies in patients allocated to the PRP group and the control group according to the type of PRP used. Color images are available online.

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