Meta-analysis of platelet-rich plasma for venous ulcers: Clinical efficacy and complications

Abstract

Background: Venous leg ulcers (VLUs) are a consequence of chronic venous insufficiency, resulting in prolonged healing, high recurrence rates, and substantial economic burden. Traditional treatments, including compression therapy and wound care management, often lead to slow and incomplete healing. Platelet-rich plasma (PRP) is a potential therapy for enhancing wound healing, though its effectiveness remains debated. This systematic review and meta-analysis assessed PRP's impact on wound healing in VLUs compared to conventional treatments.

Methods: A systematic search was conducted in the PubMed and Web of Science databases and 13 studies with a total of 554 patients were included. Healing outcomes, including complete and partial ulcer healing rates, were analyzed using binary random-effects models. Heterogeneity across studies was assessed using tau², Q-tests, and I² statistics.

Results: Meta-analysis demonstrated that PRP treatment was associated with a 1.5-fold higher odds of complete wound healing compared with conventional treatments (95% CI 1.09-2.07) (I² = 58%). Ulcer area reduction was higher in the PRP group (OR: 16.37 [95% CI 6.45-26.28], I² = 97%). Complete healing at the fourth week showed a meta-analytical OR 3.65 [1.08-12.32] with substantial heterogeneity (I² = 61%, p < 0.001). Meta-regression revealed a significant positive association between age and treatment effect, whereas diabetes mellitus was a significant negative predictor. PRP reduced ulcer recurrence (OR: 0.25 [95% CI 0.06-0.99], p < 0.001) with low heterogeneity.

Conclusion: PRP was associated with improved healing outcomes in VLUs and significantly enhanced wound healing. These findings suggest that PRP may enhance wound healing in venous leg ulcers and warrant further high-quality, large-scale randomized controlled trials to confirm its clinical applicability.

Keywords: Chronic venous insufficiency; Chronic wounds; Platelet-rich plasma; Ulcer closure; Venous leg ulcer; Wound healing.