Aim and objective: The present study aimed to evaluate the effect of tranexamic acid on the stability of platelet-rich fibrin (PRF) and its influence on connective tissue healing in Wistar rats.
Materials and methods: This experimental study included 12 male Wistar rats in three groups; group I–control (saline), group II–untreated PRF, and group III–PRF treated with tranexamic acid (PRF + TXA). Platelet-rich fibrin membrane was prepared by drawing blood from each rat and the prepared membrane was cut into two halves wherein one half was treated with tranexamic acid. After anesthetizing the animal, a linear incision was made on the mid-posterior part of the dorsal side of the body to expose the muscle and three sites were prepared. Sterile saline was applied in the control site, untreated PRF membrane was placed in group II site, and PRF + TXA in group III site. Six rats were sacrificed at 14 days and the other six at 28 days. Specimens were subjected to histological evaluation for measuring the remaining PRF and immunohistochemical analysis for evaluating vimentin expression for assessing connective tissue healing.
Results: Histopathological evaluation revealed that group III had more area of aggregation of PRF bundles at 28 days than group II. On immunohistochemical imaging, the intensity and proportionality score of vimentin expression was more in group III at 28 days.
Conclusion: From the study, it can be concluded that tranexamic acid is effective in delaying the degradation of the PRF membrane and has a positive influence on connective tissue healing.
Clinical significance: Improved stability of PRF observed with the addition of tranexamic acid will have wider applications in regenerative therapy using PRF.
Lang NP, Tonetti MS. Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev Dent 2003;1(1):7–16.
Raja S, Byakod G, Pudakalkatti P. Growth factors in periodontal regeneration. Int J Dent Hyg 2009;7(2):82–89. DOI: 10.1111/j.1601-5037.2009.00380.x.
Giannobile WV. Periodontal tissue engineering by growth factors. Bone 1996;19(1 Suppl):S23–S37. DOI: 10.1016/s8756-3282(96)00127-5.
Choukroun J, Simonpieri A, Girard M-O, et al. Platelet rich fibrin (PRF): un nouveau biomatériau de cicatrisation. Implantodontie 2004;13(4):229–235. DOI: 10.1016/j.implan.2004.07.002.
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(3):e51–e55. DOI: 10.1016/j.tripleo.2005.07.010.
Chang Y-C, Zhao J-H. Effects of platelet-rich fibrin on human periodontal ligament fibroblasts and application for periodontal infrabony defects. Aust Dent J 2011;56(4):365–371. DOI: 10.1111/j.1834-7819.2011.01362.x.
Panda S, Sankari M, Satpathy A, et al. Adjunctive effect of autologus platelet-rich fibrin to barrier membrane in the treatment of periodontal intrabony defects. J Craniofac Surg 2016;27(3):691–696. DOI: 10.1097/SCS.0000000000002524.
Lundquist R, Dziegiel MH, Agren MS. Bioactivity and stability of endogenous fibrogenic factors in platelet-rich fibrin. Wound Repair Regen 2008;16(3):356–363. DOI: 10.1111/j.1524-475X.2007.00344.x.
Sam G, Vadakkekuttical RJ, Amol NV. In vitro evaluation of mechanical properties of platelet-rich fibrin membrane and scanning electron microscopic examination of its surface characteristics. J Indian Soc Periodontol 2015;19(1):32–36. DOI: 10.4103/0972-124X.145821.
Yamashita Y, Chen Kang, Kuroda S, et al. Stability of platelet rich fibrin in vivo: histological study in rats. J Oral Tissue Engin 2016;14:83–90.
Svanberg L, Astedt B, Nilsson IM. Abruptio placentae--treatment with the fibrinolytic inhibitor tranexamic acid. Acta Obstet Gynecol Scand 1980;59(2):127–130. DOI: 10.3109/00016348009154628.
Dunn CJ, Goa KL. Tranexamic acid. Drugs 1999;57(6):1005–1032. DOI: 10.2165/00003495-199957060-00017.
Senghore N, Harris M. The effect of tranexamic acid (cyclokapron) on blood loss after third molar extraction under a day case general anaesthetic. Br Dent J 1999;186(12):634–636. DOI: 10.1038/sj.bdj.4800183.
Forbes CD, Barr RD, Reid G, et al. Tranexamic acid in control of haemorrhage after dental extraction in haemophilia and Christmas disease. Br Med J 1972;2(5809):311–313. DOI: 10.1136/bmj.2.5809.311.
Radha V, Varghese SS. In vitro analysis to analyse the disintegration property of PRF when treated with various concentration of tranexamic acid. Int J Pharmaceut Sci Res 2018;9:4912–4916.
Franke WW, Hergt M, Grund C. Rearrangement of the vimentin cytoskeleton during adipose conversion: formation of an intermediate filament cage around lipid globules. Cell 1987;49(1):131–141. DOI: 10.1016/0092-8674(87)90763-x.
Vinckier F, Vermylen J. Blood loss following dental extractions in anticoagulated rabbits: effects of tranexamic acid and socket packing. Oral Surg Oral Med Oral Pathol 1985;59(1):2–5. DOI: 10.1016/0030-4220(85)90105-7.
Lekovic V, Milinkovic I, Aleksic Z, et al. Platelet-rich fibrin and bovine porous bone mineral vs. platelet-rich fibrin in the treatment of intrabony periodontal defects. J Periodontal Res 2012;47(4):409–417. DOI: 10.1111/j.1600-0765.2011.01446.x.
Sharma A, Pradeep AR. Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: a randomized controlled clinical trial. J Periodontol 2011;82(12):1705–1712. DOI: 10.1902/jop.2011.110075.
Joseph VR, Rosamma Joseph V, Raghunath A, et al. Clinical effectiveness of autologous platelet rich fibrin in the management of infrabony periodontal defects. Singapore Dent J 2012;33(1):5–12. DOI: 10.1016/j.sdj.2012.10.003.
Panda S, Jayakumar N, Sankari M, et al. Platelet rich fibrin and xenograft in treatment of intrabony defect. Contemp Clin Dent 2014;5(4):550–554. DOI: 10.4103/0976-237X.142830.
Panda S, Doraiswamy J, Malaiappan S, et al. Additive effect of autologous platelet concentrates in treatment of intrabony defects: a systematic review and meta-analysis. J Investig Clin Dent 2016;7(1):13–26. DOI: 10.1111/jicd.12117.
Aroca S, Keglevich T, Barbieri B, et al. 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(2):244–252. DOI: 10.1902/jop.2009.080253.
Padma R, Shilpa A, Kumar PA, et al. A split mouth randomized controlled study to evaluate the adjunctive effect of platelet-rich fibrin to coronally advanced flap in Miller's class-I and II recession defects. J Indian Soc Periodontol 2013;17(5):631–636. DOI: 10.4103/0972-124X.119281.
Kantarci A, Hasturk H, Van, et al. Animal models for periodontal regeneration and peri-implant responses. Periodontol 2000 2015;68(1):66–82. DOI: 10.1111/prd.12052.
Clause BT. The Wistar rat as a right choice: establishing mammalian standards and ideal of a standardised mammal. J Hist Biol 1993;26(2):329–349. DOI: 10.1007/BF01061973.
Graves DT, Fine D, Teng Y-TA, et al. The use of rodent models to investigate host-bacteria interactions related to periodontal diseases. J Clin Periodontol 2008;35(2):89–105. DOI: 10.1111/j.1600-051X.2007.01172.x.
Dorsett-Martin WA, Wysocki AB. Rat models of skin wound healing. Sourcebook Mod Biomed Res, 631–638.
Del Fabbro M, Karanxha L, Panda S, et al. Autologous platelet concentrates for treating periodontal infrabony defects. Cochrane Database Syst Rev 2018;11:CD011423. DOI: 10.1002/14651858.CD011423.pub2.
Panda S, Ramamoorthi S, Jayakumar ND, et al. Platelet rich fibrin and alloplast in the treatment of intrabony defect. J Pharm Bioallied Sci 2014;6(2):127–131. DOI: 10.4103/0975-7406.129178.
Ravi S, Malaiappan S, Varghese S, et al. Additive effect of plasma rich in growth factors with guided tissue regeneration in treatment of intrabony defects in patients with chronic periodontitis: a split-mouth randomized controlled clinical trial. J Periodontol 2017;88(9):839–845. DOI: 10.1902/jop.2017.160824.