PRP vs PRF - What are the Differences?

If you’ve been following the PRP (platelet-rich plasma) space for a while, you’ve likely heard of PRF, also known as platelet-rich fibrin. Many claim PRF is superior because it’s a second-generation platelet concentrate.

But it may not be that simple. And we believe each has its own place in the regenerative medicine field.

To understand the advantages and disadvantages of each, let’s look at their differences.

PRP vs. PRF – Processing Differences

In general, PRP extraction protocols can be divided into 2 parts as follows:¹

1. The Dr. PRP Kit makes PRP preparation easy and quick. In a syringe, take 2 cc of anticoagulant and draw 18 cc of blood from the patient. Load the blood and anticoagulant mixture through the upper injection port of a Dr. PRP Kit until the blood level reaches 20 cc (marked on the tube). Then separate the plasma layer and red blood cell (RBC) layer using the Dr. PRP centrifuge. A second centrifugation step is needed to concentrate the platelets. The Dr. PRP Kit produces 4 cc of highly concentrated PRP, a recovery rate higher than similar PRP products on the market.
2. Once the PRP is obtained, it’s mixed with activators (either thrombin or calcium chloride) at the time of the application. The activators induce the release of growth factors from platelets and fibrin polymerization, a necessary step to stop bleeding at the site of injury.²

At this point, you might be asking: Why use anticoagulants?

Anticoagulants play a crucial role in processing PRP. Sometimes blood samples can’t be processed immediately for various reasons, such as the availability of necessary equipment. In such a case, anticoagulants are necessary to keep the blood from clotting. Once blood starts clotting, the chances of deriving a workable PRP solution decrease. However, since these anticoagulants are considered additives and not derived from the patient, immunogenic reactions are possible.

Now let’s look at PRF processing. Unlike PRP, PRF is obtained by centrifuging blood without the use of any additives like anticoagulants. Without an anticoagulant, PRF forms a fibrin matrix gelatinous clot in the test tube. This fibrin matrix helps confine growth factor secretion to the injection site. Research also indicates that fibroblasts reorganize this fibrin matrix to promote collagen synthesis.³ The centrifugation speed is also much lower than that used for PRP, which is thought to protect cells from damage.

PRF also contains a type of immune cell called leukocytes, which secrete signaling factors that encourage tissue repair and stem cell recruitment. PRP can be leukocyte rich as well, though some clinicians prefer leukocyte-poor PRP under certain circumstances. In a recent study involving patients with knee osteoarthritis, the investigators observed no differences in the effects of leukocyte-rich and leukocyte-poor PRP.⁴

PRP vs. PRF - Differences in Release of Growth Factors

Another major difference lies in the kinetics of PRP and PRF. With PRP, the initial release of growth factor occurs rapidly, which means earlier healing benefits. Kobayashi and colleagues compared PRP, PRF, and advanced PRF (A-PRF), and found that PRP released a significantly higher amount of proteins at earlier time points compared to PRF and A-PRF. On the other hand, PRF displayed a more steady release of growth factors over the 10-day observation period.⁵

Some argue that the benefits of PRP, while rapid, are short-lived. But there are many studies demonstrating that this is simply untrue. In one study involving 31 patients with lateral epicondylitis, positive effects of PRP injections were seen even several years afterwards.⁶

Another study looking at the effect of PRP for knee osteoarthritis reported that 85% of patients had clinically meaningful improvements at their 6- and 12-month follow-up visits.⁷

So while the results may not be permanent, the results from these studies show that PRP can be quite effective, even long-term.

Frequently Asked Questions

Can We Use an EDTA Tube for PRP?

EDTA, or ethylenediaminetetraacetic acid, is an anticoagulant used in the processing of PRP. It was once thought that EDTA shouldn’t be used because it could cause platelet activation and could damage the platelet membrane by platelet swelling.⁸ Instead, some clinicians used anticoagulants with citrate and dextrose of sodium citrate.⁹

One study compared the effects of EDTA to those of two other anticoagulants, heparin and A-form of acid-citrate-dextrose (ACD-A). The authors reported that while EDTA indeed caused significant platelet swelling and activation, it was more efficient than the others for inhibiting platelet aggregation and platelet collection. They also noted that the preparation of a well-suspended and homogenous PRP was much easier using EDTA. EDTA also yielded the highest number of platelets.¹⁰

Some have also expressed concerns that EDTA suppresses the regenerative activity of certain cells.¹¹ However, it’s important to note that these findings were from in vitro studies. When used in an animal model, EDTA-anticoagulated PRP preparations in combination with adipose-derived stem cells showed no apparent adverse effects.¹²

So with careful use, EDTA can be used to simplify and optimize your PRP preparation.

Can You Use the Same Centrifuge for PRP and PRF?

Yes, you can use the same centrifuge for PRP and PRF. You’ll just want to follow the protocol provided by the manufacturer of the kit.

Best Centrifuge and Kit for PRP and PRF

The Dr. PRP centrifuge includes complete instructions for the development of both PRP and PRF. 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 look forward to serving you.