Nonsteroidal Anti-inflammatory Drugs and Platelet-Rich Plasma Injections

NSAIDs and platelet-rich plasma injections Platelet-rich plasma (PRP) injections can be used for a variety of indications, including musculoskeletal injuries and conditions. By concentrating platelets, growth factors, and cytokines, PRP injections help accelerate tissue healing and reduce pain and inflammation. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) inhibit cyclooxygenase (COX) enzymes in platelets, which reduces platelet activation and the release of those same growth factors and inflammatory mediators. If a patient comes into the ED with pain and a history of recent PRP injections, can we/should we use NSAIDs? It has been shown that one week of naproxen use significantly decreased levels of growth factors. Because these biological factors are thought to contribute to PRP’s healing effects, NSAID use may blunt the PRP injections' biological activity. This being said, relevant factors to consider are the patient's reason for presentation, the ability to use alternative analgesics such as acetaminophen, and the time since the last PRP injection. Many institutions recommend holding NSAIDs for 2 weeks following PRP injections. Therefore, it is important for emergency medicine pharmacists and clinicians to be aware of this notable interaction between PRP and NSAIDs, which could affect analgesic recommendations in the ED. Mannava S, Whitney KE, Kennedy MI, et al. The Influence of Naproxen on Biological Factors in Leukocyte-Rich Platelet-Rich Plasma: A Prospective Comparative Study. Arthroscopy. 2019;35(1):201-210. doi:10.1016/j.arthro.2018.07.030 Wu WS, Chen LR, Chen KH. Platelet-Rich Plasma (PRP): Molecular Mechanisms, Actions and Clinical Applications in Human Body. Int J Mol Sci. 2025;26(21):10804. Published 2025 Nov 6. doi:10.3390/ijms262110804 Ngo VTH, Bajaj T. Ibuprofen. StatPearls. 2024 Aug 11. https://www.ncbi.nlm.nih.gov/books/NBK542299/