Costo y efectividad del Plasma Rico en Plaquetas en la cicatrización de úlcera varicosa: Metaanálisis

Oliveira, Beatriz Guitton Renaud Baptista de; Carvalho, Magali Rezende de; Ribeiro, Andrea Pinto Leite

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2018-0981 copiar

Costo y efectividad del Plasma Rico en Plaquetas en la cicatrización de úlcera varicosa: Metaanálisis

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

analizar las evidencias acerca del costo y de la efectividad del Plasma Rico en Plaquetas en el tratamiento de úlceras venosas comparado a las otras terapias tópicas.

Métodos:

revisión sistemática con la búsqueda en bases de datos: Cochrane Library, EMBASE, MEDLINE vía PubMed, LILACS, CINAHL, SCOPUS, hay un tiempo y en inglés, portugués y español.

Resultados:

se incluyeron 15 artículos, un análisis de costo-minimización demostró que el costo del Plasma Rico en Plaquetas es de € 163,00 ± 65,90, poco superior al costo del vendaje estándar. En cuanto a la efectividad, los resultados de los estudios asociados al metaanálisis sugieren una tendencia de que el Plasma Rico en Plaquetas es efectivo en la cicatrización de las úlceras venosas.

Conclusiones:

se concluye que hay pocos estudios acerca del costo del Plasma Rico en Plaquetas y que ese tiende a ser efectivo en la cicatrización de úlceras venosas. Todavía, son necesarios más estudios clínicos controlados y aleatorizados para que se pueda establecer una recomendación más fuerte.

Descriptores:
Plasma Rico en Plaquetas; Úlcera Varicosa; Costos y Análisis de Costo; Cicatrización de Heridas; Metaanálisis

Author/ Year/ Country	Study design	Interventions/ No. of participants	Level of evidence/ Grade for recommendation Oxford
Burgos-Alonso et al.⁽¹⁴14 Burgos-Alonso N, Lobato I, Hernandez I, Sebastian KS, Rodriguez B, March AG, et al. Autologous platelet-rich plasma in the treatment of venous leg ulcers in primary care: a randomised controlled, pilot study. J Wound Care. 2018;27(Sup6):S20-S4. doi: 10.12968/jowc.2018.27.Sup6.S20 https://doi.org/10.12968/jowc.2018.27.Su... ⁾ 2018 Spain	Pilot Randomized controlled trial with cost -minimization analysis follow-up time (FT) = 9 weeks	Platelet-Rich Plasma Gel (n = 7) versus Standard treatment (n = 5)	1b/A
Moneibet al.⁽¹⁵15 Moneib HA, Youssef SS, Aly DG, Rizk MA, Abdelhakeem YI. Autologous platelet-rich plasma versus conventional therapy for the treatment of chronic venous leg ulcers: A comparative study. J Cosmet Dermatol. 2018;17(3):495-501. doi: 10.1111/jocd.12401 https://doi.org/10.1111/jocd.12401... ⁾ 2018 Egypt	Case-control FT = 6 weeks	Platelet-Rich Plasma (n = 20) versus C onventional therapy with vaseline gauze and saline (n = 20)	3b/B
Cardeñosaet al.⁽¹⁶16 Cardeñosa ME, Dominguez-Maldonado G, Cordoba-Fernandez A. Efficacy and safety of the use of platelet-rich plasma to manage venous ulcers. J Tissue Viability. 2017;26(2):138-43. doi: 10.1016/j.jtv.2016.11.003 https://doi.org/10.1016/j.jtv.2016.11.00... ⁾ 2017 Spain	Randomized controlled trial FT = 24 weeks	Platelet rich in growth factor (n = 55) versus Saline solution (n = 47)	1b/A
Somani&Rai⁽¹⁷17 Somani A, Rai R. Comparison of efficacy of Autologous Platelet-rich Fibrin versus Saline Dressing in Chronic Venous Leg Ulcers: a randomised controlled trial. J Cutan Aesthet Surg. 2017;10(1):8-12. doi: 10.4103/JCAS.JCAS_137_16 https://doi.org/10.4103/JCAS.JCAS_137_16... ⁾ 2017 India	Randomized controlled trial FT = 4 weeks	Platelet-rich fibrin (n = 9) versus Saline solution (n = 6)	1b/A
Senet et al.⁽¹⁸18 Senet P, Bon FX, Benbunan M, Bussel A, Traineau R, Calvo F, et al. Randomized trial and local biological effect of autologous platelets used as adjuvant therapy for chronic venous leg ulcers. J Vasc Surg. 2003;38(6):1342-8. doi: 10.1016/S0741 https://doi.org/10.1016/S0741... ⁾ 2003 France	Randomized Double-blind Clinical Trial FT = 12 weeks	Frozen autologous platelets (n = 8) versus Hydrocolloid (n = 7)	1b/A
Stacey et al.⁽¹⁹19 Stacey MC, Mata SD, Trengove NJ, Mather CA. Randomised double-blind placebo-controlled trial of topical autologous platelet lysate in venous ulcer healing. Eur J Vasc Endovasc Surg;20(3):296-301. doi: 10.1053/ejvs.2000.1134 https://doi.org/10.1053/ejvs.2000.1134... ⁾ 2000 Australia	Randomized Double-blind Clinical Trial FT = 9 months	Platelet lysate (n = 42) Versus Placebo (n = 44)
Pinto et al.⁽²⁰20 Pinto NR, Ubilla M, Zamora Y, Del Rio V, Dohan Ehrenfest DM, Quirynen M. Leucocyte- and platelet-rich fibrin (L-PRF) as a regenerative medicine strategy for the treatment of refractory leg ulcers: a prospective cohort study. Platelets. 2018;29(5):468-75. doi: 10.1080/09537104.2017.1327654 https://doi.org/10.1080/09537104.2017.13... ⁾ 2018 Chile	Prospective Cohort FT = 1 year	Leucocyte- and platelet-rich fibrin (L-PRP) (n = 32)	2b/B
Waniczeket al.⁽²¹21 Waniczek D, Mikusek W, Kaminski T, Wesecki M, Lorenc Z, Cieslik-Bielecka A. The "biological chamber" method - use of autologous platelet-rich plasma (PRP) in the treatment of poorly healing lower-leg ulcers of venous origin. Pol Przegl Chir. 2015;87(6):283-9. doi: 10.1515/pjs-2015-0055. https://doi.org/10.1515/pjs-2015-0055... ⁾ 2015 Poland	Case series FT = 10 weeks	Platelet-Rich Plasma (n = 10)	4/C
Kim et al.⁽²²22 Kim SA, Ryu HW, Lee KS, Cho JW. Application of platelet-rich plasma accelerates the wound healing process in acute and chronic ulcers through rapid migration and upregulation of cyclin A and CDK4 in HaCaT cells. Mol Med Rep. 2013;7(2):476-80. doi: 10.3892/mmr.2012.1230 https://doi.org/10.3892/mmr.2012.1230... ⁾ 2013 Republic of Korea	Case series FT = Not informed	Autologous platelet gel or liquid (n = 3)	4/C
Park et al.⁽²³23 Park KY, Kim IS, Yeo IK, Kim BJ, Kim MN. Treatment of refractory venous stasis ulcers with autologous platelet-rich plasma and light-emitting diodes: a pilot study. J Dermatolog Treat. 2013;24(5):332-5. doi: 10.3109/09546634.2012.735637 https://doi.org/10.3109/09546634.2012.73... ⁾ 2013 South Korea	Pilot study FT = 6 weeks	Platelet-Rich Plasma Gel (n= 16)	4/C
Sarvajnamurphyet al.⁽⁷7 Sarvajnamurthy S, Suryanarayan S, Budamakuntala L, Suresh DH. Autologous platelet rich plasma in chronic venous ulcers: study of 17 cases. J Cutan Aesthet Surg.2013;6(2):97-9. doi: 10.4103/0974-2077.112671 https://doi.org/10.4103/0974-2077.112671... ⁾ 2013 India	Case series FT = 6 weeks	Platelet Gel (n = 17)	4/C
Leon et al.⁽²⁴24 Leon JM, Driver VR, Fylling CP, Carter MJ, Anderson C, Wilson J, et al. The clinical relevance of treating chronic wounds with an enhanced near-physiological concentration of platelet-rich plasma gel. Adv Skin Wound Care. 2011;24(8):357-68. doi: 10.1097/01.ASW.0000403249.85131.6f https://doi.org/10.1097/01.ASW.000040324... ⁾ 2011 USA	Observational study with databases from 39 centers FT = 2.1 weeks	Platelet-Rich Plasma Gel (Autologel™) (n = 32)	4/C
Frykberget al.⁽²⁵25 Frykberg RG, Driver VR, Carman D, Lucero B, Borris-Hale C, Fylling CP, et al. Chronic wounds treated with a physiologically relevant concentration of platelet-rich plasma gel: a prospective case series. Ostomy Wound Manage [Internet]. 2010 [cited 2018 Aug 08];56(6):36-44. Available from: https://www.o-wm.com/content/chronic-wounds-treated-physiologically-relevant-concentration-platelet-rich-plasma-gel-prosp. https://www.o-wm.com/content/chronic-wou... ⁾ 2010 USA	Case series FT = 2.8 weeks	Platelet-Rich Plasma Gel (Autologel™) (n = 16)	4/C
O'Connell et al.⁽²⁶26 O'Connell SM, Impeduglia T, Hessler K, Wang XJ, Carroll RJ, Dardik H. Autologous platelet-rich fibrin matrix as cell therapy in the healing of chronic lower-extremity ulcers. Wound Repair Regen. 2008;16(6):749-56. doi: 10.1111/j.1524-475X.2008.00426.x https://doi.org/10.1111/j.1524-475X.2008... ⁾ 2008 USA	Pilot study FT = 16 weeks	Autologous platelet-rich fibrin membrane (PRFM)/ 1 to 3 applications/ (n = 17) Size. 11.2 (0.7-58)	4/C
Gürgen, M⁽²⁷27 Gürgen M. Treatment of chronic wounds with autologous platelet-rich plasma. EWMA Journal [Internet]. 2008 [cited 2018 Aug 08];8(2):5-10. Available from: https://pdfs.semanticscholar.org/b559/e80bee2ad1591847cb514c741a4fee2befa5.pdf https://pdfs.semanticscholar.org/b559/e8... ⁾ 2008 Norway	Prospective study FT = 10 months	Platelet-Rich Plasma (n = 7)	4/C

Author/ Year	Area reduction in cm² Mean (SD)		Percentage of area reduction (%) Mean (SD)		Nº of ulcers completely healed/ total		Mean time to healing Mean (SD)
Author/ Year	IG¹	CG²	IG	CG	IG	CG	IG	CG
Burgos-Alonso, 2018	3.9	3.2	82.8	40.8	4.2/7	1/5	NI³	NI
Moneib, 2018	4.92 (11.94)	0.13 (0.27)	67.6 (36.6)	13.67 (28.06)	7/20	0/20	NI	NI
Cardeñosa, 2017	3.7	4.53	67.7 (41.54)	11.17 (24.4)	NI	NI	NI	NI
Somani & Rai, 2017	NI	NI	85.51	42.74	5/9	0/6	NI	NI
Senet, 2003	NI	NI	26.2	15.2	1/8	1/7	12 weeks⁴	4 weeks
Stacey, 2000	NI	NI	NI	NI	33/42	34/44	75% in 3 months	75% in 3 months
Pinto, 2018	NI	NI	NI	NI	27/32	NA⁵	9 a 15 weeks	NA
Waniczek, 2015	NI	NI	NI	NI	10/10	NA	10 weeks	NA
Kim, 2013	NI	NA	90 a 95	NA	0/3	NA	20 a 24 days	NA
Park, 2013	0.48 (0.95)	NA	NI	NA	0/16	NA	NA	NA
Sarvajnamurphy, 2013	NI	NA	94.7 (11.12)	NA	13/17	NA	5.1 (3.1) weeks	NA
Leon, 2011	NI	NA	40.2 (26.6)	NA	0/32	NA	2.1 weeks	NA
Frykberg, 2010	NI	NA	43.1 (32.4)	NA	0/16	NA	2.3 (1.4) weeks	NA
O'Connell, 2008	NI	NA	NI 02 with healing >75%	NA	11/17	NA	7.1 weeks	NA
Gürgen, 2008	NI	NA	93.2 59.7 72	NA	3/7	NA	35 233 238 days	NA

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[1] Corresponding author: Beatriz Guitton Renaud Baptista de Oliveira E-mail: beatrizguitton@globo.com