PRP vs. PRF – Which is More Effective?

The phenomena of wound healing and tissue regeneration have intrigued researchers and medical professionals for decades. Platelets, a natural component of your blood, have gained special attention thanks to their high concentration of growth factors that stimulate wound healing. This favorable property has led to the development of autologous platelet concentrates like platelet-rich plasma (PRP) and platelet-rich fibrin (PRF).

PRP represents a “first generation” autologous platelet concentrate. And since the development of PRF, many people have debated the superiority of one over the other.

So, have we come to a definitive answer? Read on to find out.

What is PRP?

Before we begin, let’s discuss PRP and PRF and their differences.

Both PRP and PRF are derived from autologous blood, meaning they come from your own blood. It also means they have outstanding safety profiles since your body is unlikely to reject it.

A healthy individual has a normal platelet count that ranges between 150,000 and 350,000 cells/microliters of blood.¹ This concentration can be magnified several times by centrifugation, a process in which the blood is spun down at a high speed to separate the blood into different layers. While a natural blood clot only contains about 5% platelets, PRP contains 95% platelets.²

Platelets release several types of growth factors, which enable PRP to have such a profound effect on wound healing. Here are the growth factors found in PRP and their function(s):³

• Platelet-derived growth factor (PDGF): PDGF triggers the activities of various immune cells, including neutrophils, fibroblasts, and macrophages. They also regulate cell growth and division.
• Transforming growth factor beta (TGF-b): They’re responsible for cellular differentiation, replication, and collagen production
• Vascular endothelial growth factor (VEGF): VEGFs promote angiogenesis (the formation of new blood vessels), which is especially helpful if your tissues aren’t getting enough oxygen.
• Fibroblast growth factor (FGF): FGFs also play an important role in angiogenesis and fibroblast production. Fibroblasts are the principal cells of connective tissues.
• Epithelial cell growth factor (ECGF): ECGFs stimulate epithelial cell replication
• Insulin-like growth factor (IGF-1): IGF-1 promotes cellular growth and proliferation
• Connective tissue growth factor (CTGF): CTGFs promote angiogenesis, cartilage regeneration, and platelet adhesion.

To harness the abilities of these growth factors, an anticoagulant is added to the blood to prevent clotting during processing. A platelet activator like calcium chloride or thrombin, which are often derived from bovines, also need to be added to the PRP preparation.³ These additives may pose a risk to sensitive individuals.

What is PRF?

PRF is considered a “second generation” autologous platelet concentrate.⁴ Like PRP, blood is taken from the patient and spun down in a centrifuge to separate it into distinct layers.

For PRF, your blood is spun at a lower speed, resulting in less damage to cells. The slower speed also means that the platelet layer in PRF contains some stem cells, white blood cells, and fibrin.

Fibrin is the key difference between PRF and PRP. It’s the activated form of fibrinogen – a molecule in your plasma that plays a role in the formation of blood clots. When activated, fibrin becomes a substance that can be thought of as a “biologic glue” that forms the initial platelet cluster.⁵

Unlike PRP, PRF doesn’t require the use of coagulants. The lack of an anticoagulant means the blood sample will have to be processed quickly. Without an anticoagulant present, fibrinogen in blood gets converted into a spongy fibrin matrix, which can be used as a membrane to slowly release growth factors to the surrounding environment.⁶ In tissues, fibroblasts are also recruited to reorganize the fibrin matrix and begin collagen synthesis.⁷

Joseph Choukroun and colleagues, who introduced PRF in 2000, published a series of articles detailing the development, properties, and potential clinical impact of PRF. In part IV of the series, they presented 3 highly specific aspects of the fibrin matrix that promotes healing, which include:⁸

• The direct induction of angiogenesis by fibrin
• The stimulation of neutrophil and monocyte migration by fibrin and fibrinogen degradation products, thereby providing natural support to immunity
• The guidance of wound coverage by the fibrin matrix

The fibrin matrix also acts as a net to stem cells and cytokines, which can assist in healing.⁸

Which is More Effective?

At first glance, many people would argue that PRF is the superior choice. Certainly, PRF has various advantages over PRP and other first-generation platelet concentrates. Without the addition of anticoagulants, PRF is a much more straightforward procedure and delivers a higher concentration of platelets.

But to determine which is better may come down to the effect you’re looking for. A study by Kobayashi and colleagues found that the initial release of growth factors occurred much more rapidly with PRP than with PRF. This means you’ll experience healing benefits faster than you would with PRF. On the other hand, the release of growth factors in PRF was more gradual but sustained for a longer period of time.⁶

That doesn’t mean PRP is ineffective long-term. Several studies have been published indicating that PRP injections could provide benefits over time for various conditions, such as knee osteoarthritis and plantar fasciitis. In one study involving 118 human patients with plantar fasciitis, maximal benefits of PRP were actually observed at 6 months.⁹

A Superior Solution to Healing

Both PRP and PRF have their advantages. And much more research has to be done to truly understand how they work in the human body.

The Dr. PRP Centrifuge and Kit is compatible with both PRP and PRF/PRFM and includes complete instructions for the development of both products. Our closed, sterile system is quick and easy to use and provides consistent quality and results.

If you’re a physician who would like to further discuss the benefits of PRP or PRF for your patients, call us at (844) 377-7787 (DR-PRP-US). We would be honored to help you.