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Tranexamic acid integrated into platelet-rich fibrin produces a robust and resilient antihemorrhagic biological agent: a human cohort study

Published:March 17, 2022DOI:https://doi.org/10.1016/j.oooo.2022.03.006

      Objective

      To investigate the incorporation of the antifibrinolytic agent tranexamic acid (TA) during platelet-rich fibrin (PRF) formation to produce a robust fibrin agent with procoagulation properties.

      Study Design

      Blood from healthy volunteers was collected. Into 3 tubes, TA was immediately added in 1-mL, 0.4-mL, and 0.2-mL volumes, and the fourth tube was without additions. After PRF preparation, the clots were weighed in their raw (clot) and membrane forms. PRF physical properties were analyzed using a universal testing system (Instron). Protein and TA levels in the PRF were analyzed using a bicinchoninic acid assay and a ferric chloride assay, respectively.

      Results

      The addition of TA to PRF led to a robust weight compared with sham control. PRF weight was greater in females in all tested groups. The addition of TA also led to greater resilience to tears, especially at 1-mL TA addition to the blood. Furthermore, TA addition led to a greater value of total protein within the PRF and entrapment of TA in the PRF.

      Conclusions

      Addition of TA to a PRF preparation leads to robust PRF with greater protein levels and the amalgamation of TA into the PRF. Such an agent may enhance the beneficial properties of PRF and attribute procoagulation properties to it.
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      References

        • Matras H.
        Effect of various fibrin preparations on reimplantations in the rat skin.
        Osterr Z Stomatol. 1970; 67 ([in German]): 338-359
        • Marx RE
        • Carlson ER
        • Eichstaedt RM
        • Schimmele SR
        • Strauss JE
        • Georgeff KR.
        Platelet-rich plasma: growth factor enhancement for bone grafts.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 638-646
        • Dohan DM
        • Choukroun J
        • Diss A
        • et al.
        Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: e37-e44
        • Dohan DM
        • Choukroun J
        • Diss A
        • et al.
        Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates?.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: e51-e55
        • Ghanaati S
        • Booms P
        • Orlowska A
        • et al.
        Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells.
        J Oral Implantol. 2014; 40: 679-689
        • Dohan DM
        • Choukroun J
        • Diss A
        • et al.
        Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: e45-e50
        • Schar MO
        • Diaz-Romero J
        • Kohl S
        • Zumstein MA
        • Nesic D.
        Platelet-rich concentrates differentially release growth factors and induce cell migration in vitro.
        Clin Orthop Relat Res. 2015; 473: 1635-1643
        • Ajwani H
        • Shetty S
        • Gopalakrishnan D
        • et al.
        Comparative evaluation of platelet-rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects.
        J Int Oral Health. 2015; 7: 32-37
        • Agarwal A
        • Gupta ND
        • Jain A.
        Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trial.
        Acta Odontol Scand. 2016; 74: 36-43
        • Bajaj P
        • Pradeep AR
        • Agarwal E
        • et al.
        Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial.
        J Periodontal Res. 2013; 48: 573-581
        • Aroca S
        • Keglevich T
        • Barbieri B
        • Gera I
        • Etienne D
        Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study.
        J Periodontol. 2009; 80: 244-252
        • Thamaraiselvan M
        • Elavarasu S
        • Thangakumaran S
        • Gadagi JS
        • Arthie T.
        Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of isolated gingival recession.
        J Indian Soc Periodontol. 2015; 19: 66-71
        • Novikova N
        • Hofmeyr GJ
        • Cluver C.
        Tranexamic acid for preventing postpartum haemorrhage.
        Cochrane Database Syst Rev. 2015; CD007872
        • Reust DL
        • Reeves ST
        • Abernathy 3rd, JH
        • et al.
        Temporally and regionally disparate differences in plasmin activity by tranexamic acid.
        Anesth Analg. 2010; 110: 694-701
        • Sentilhes L
        • Lasocki S
        • Ducloy-Bouthors AS
        • et al.
        Tranexamic acid for the prevention and treatment of postpartum haemorrhage.
        Br J Anaesth. 2015; 114: 576-587
        • Sindet-Pedersen S.
        Distribution of tranexamic acid to plasma and saliva after oral administration and mouth rinsing: a pharmacokinetic study.
        J Clin Pharmacol. 1987; 27: 1005-1008
        • Clemm R
        • Neukam FW
        • Rusche B
        • Bauersachs A
        • Musazada S
        • Schmitt CM.
        Management of anticoagulated patients in implant therapy: a clinical comparative study.
        Clin Oral Implants Res. 2016; 27: 1274-1282
        • Polak D
        • Clemer-Shamai N
        • Shapira L.
        Incorporating antibiotics into platelet-rich fibrin: a novel antibiotics slow-release biological device.
        J Clin Periodontol. 2019; 46: 241-247
        • Fujioka-Kobayashi M
        • Miron RJ
        • Hernandez M
        • Kandalam U
        • Zhang Y
        • Choukroun J.
        Optimized platelet-rich fibrin with the low-speed concept: growth factor release, biocompatibility, and cellular response.
        J Periodontol. 2017; 88: 112-121
        • Miron RJ
        • Choukroun J
        • Ghanaati S.
        Controversies related to scientific report describing g-forces from studies on platelet-rich fibrin: necessity for standardization of relative centrifugal force values.
        Int J Growth Factors Stem Cells Dentistry. 2018; 1: 80-89
        • Arayne MS
        • Sultana N
        • Siddiqui FA
        • Mirza AZ
        • Zuberi MH.
        Spectrophotometric techniques to determine tranexamic acid: kinetic studies using ninhydrin and direct measuring using ferric chloride.
        J Mol Structure. 2008; 891: 475-480
        • Castro AB
        • Meschi N
        • Temmerman A
        • et al.
        Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: I=intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis.
        J Clin Periodontol. 2017; 44: 67-82
        • Butkiewicz AM
        • Kemona H
        • Dymicka-Piekarska V
        • Matowicka-Karna J
        • Radziwon P
        • Lipska A.
        Platelet count, mean platelet volume and thrombocytopoietic indices in healthy women and men.
        Thromb Res. 2006; 118: 199-204
        • Breet NJ
        • Sluman MA
        • van Berkel MA
        • et al.
        Effect of gender difference on platelet reactivity.
        Neth Heart J. 2011; 19: 451-457
        • Nuvvula S
        • Gaddam KR
        • Kamatham R.
        Efficacy of tranexamic acid mouthwash as an alternative for factor replacement in gingival bleeding during dental scaling in cases of hemophilia: a randomized clinical trial.
        Contemp Clin Dent. 2014; 5: 49-53
        • Ferrieri GB
        • Castiglioni S
        • Carmagnola D
        • Cargnel M
        • Strohmenger L
        • Abati S.
        Oral surgery in patients on anticoagulant treatment without therapy interruption.
        J Oral Maxillofac Surg. 2007; 65: 1149-1154
        • Canellas J
        • Ritto FG
        • Medeiros PJD.
        Evaluation of postoperative complications after mandibular third molar surgery with the use of platelet-rich fibrin: a systematic review and meta-analysis.
        Int J Oral Maxillofac Surg. 2017; 46: 1138-1146
        • Ozgul O
        • Senses F
        • Er N
        • et al.
        Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: randomized multicenter split-mouth clinical trial.
        Head Face Med. 2015; 11: 37