Why the Anticoagulant in Your PRP Kit Matters

Why the Anticoagulant in Your PRP Kit Matters

(and why Juventix chooses ACD‑A over sodium citrate)

When a manufacturer issues an emphatic, highly public rebuttal to a respected clinician’s warning, seasoned healthcare professionals instinctively look closer—because “where there’s smoke, there’s usually fire.” That scenario is now playing out in the regenerative medicine arena. Dr. Charles Runels, MD, the innovator behind the Vampire Facial®, O‑Shot®, and other platelet‑rich plasma (PRP) procedures, has sounded the alarm over sodium‑citrate PRP kits—specifically those marketed by a major US company that we will call “Brand X” for the purpose of this article.

“For 14 years and many thousands of procedures, the only time persistent pain and decreased function have been reported after an O‑Shot was when the sodium‑citrate “Brand-X” kit was used.”
— Dr. Charles Runels, email newsletter, April 2025

Over the past few years, he has cataloged a dozen patient cases reporting profound sensory loss, prolonged pain, and diminished treatment efficacy. In split‑face trials the sodium‑citrate side “hurts a lot more,” while alternative kits using ACD‑A or balanced citrate formulas do not trigger the same reactions. Brand-X’s forceful response has only amplified the spotlight, prompting clinicians to ask a critical question: Is your choice of anticoagulant quietly undermining patient safety and outcomes?

This article aims to answer that question by synthesizing the peer‑reviewed clinical literature, guidance from U.S. and international regulatory bodies, real‑world pharmacovigilance reports, and head‑to‑head laboratory studies—then translating those data into clear, actionable recommendations for clinicians who refuse to compromise on patient safety or therapeutic efficacy. So, let’s dig in!

*Is “mix-in” Sodium Citrate or pre-filled ACD-A the superior anticoagulant for PRP preparation?

 

 

1 | The Regulatory Reality

The U.S. FDA has cleared only one anticoagulant for use in Autologous PRP Systems—ACD‑A (Anticoagulant Citrate Dextrose Solution A, 2.13 % free citrate ion).¹ Sodium‑citrate 4 % solutions are authorized solely for automated apheresis circuits, not for PRP injections.² Using sodium‑citrate kits off‑label therefore increases liability exposure, whereas Juventix tubes—pre‑loaded with ACD‑A—keep your practice firmly on‑label.

 

2 | Chemistry That Protects Platelets and Tissue

“Regulatory status, biochemical profile, and real‑world safety signals strongly favor ACD‑A over 4 % sodium citrate as the appropriate anticoagulant for high-quality PRP preparation.”

ACD‑A combines trisodium citrate (calcium chelator) with dextrose (metabolic fuel) and citric acid (buffer), preserving platelet ultrastructure and sustaining growth‑factor release.⁵

3 | Real‑World Safety Signal

Dr Charles Runels—originator of the Vampire Facial®, O‑Shot®, and P‑Shot®—has recorded more than a dozen cases of prolonged pain or decreased function only when sodium‑citrate “Brand-X” tubes were used.⁴ No comparable events have been reported with Juventix or other ACD‑A based systems.

*Dr. Charles Runels, MD with Juventix CEO & Founder Lance Liberti, 2015

 

 

 

4 | Patient‑Centered Comfort

A split‑face/scalp RCT (n = 20) found lower VAS scores with sodium citrate for small, superficial injections.⁶ However, intimate‑tissue procedures (e.g., O‑Shot®/P‑Shot®) involve larger volumes and deeper planes—conditions under which sodium‑citrate boluses have produced the pain cluster above. The clinical takeaway: ACD‑A matches or exceeds citrate on comfort while avoiding outlier “burn” events.

5 | What “Brand-X” own white‑paper leaves out

The formal statement in response to Dr. Runels claims of patient discomfort and injury while using “Brand-X” PRP kits drafted by their scientific director and distributed via blast email Monday, April 7^th, 2025 argues that dextrose creates a “hyper‑glycaemic milieu” that blunts angiogenesis. Yet the murine study it cites (Oneto et al., 2020) used platelet lysates, not intact PRP, and did not reproduce human clinical conditions. More importantly, the paper concedes that other sodium‑citrate kits do not share Brand-X’s pain profile, implicating kit‑specific factors (e.g., 8 mL of 4 % citrate per 52 mL blood) rather than dextrose.

6 | Risk Management & Reimbursement

• Malpractice insurers increasingly flag off‑label biologic use. Juventix provides FDA‑cleared tubes and IFUs listing ACD‑A as the integral anticoagulant.
• Medicare MAC audits now request device documentation for autologous‑blood CPT codes. Juventix simplifies compliance.
• One vendor, full support—CLIA‑waived protocols, live clinical helpline, and side‑by‑side evaluation kits.

Key Take‑Aways for Practitioners

1. Patient experience drives repeat business. Even a small increase in injection pain can translate into negative reviews and lost referrals.
2. Clinical outcomes matter. Reports of transient loss of sexual function or decreased sensitivity—even if patients eventually recover—are unacceptable risks.
3. Regulatory confidence. Juventix PRP tubes are FDA‑cleared and pre‑loaded with ACD‑A, eliminating mixing errors and ensuring lot‑to‑lot consistency.
4. Risk mitigation. Switching to an ACD‑A‑based system like Juventix removes an avoidable variable from your protocol.

The Bottom Line

Your choice of anticoagulant is not trivial. Dr. Runels’ field observations echo what many practitioners have learned first‑hand: ACD‑A delivers a smoother injection and more predictable results than sodium citrate.

If your current PRP vendor is unwilling to provide an ACD‑A option—or if you’ve experienced patient complaints—consider evaluating Juventix Regenerative Medical’s FDA‑cleared PRP system as a safe and effective alternative.

Ready to compare Juventix in your own hands? Here’s How:

• Request a FREE sample PRP kit (just pay shipping & handling) from Juventix here: juventix.com/sample-page/
• Request a side-by-side kit evaluation—Juventix will supply FDA-cleared PRP tubes containing ACD-A and instructions for use.
• Perform a split-injection test (e.g., face or knee). Document pain scores, bruising, and outcome.
• Review compliance documentation with your risk manager—note the FDA labeling differences.
• Make an informed purchasing decision—based on real-world outcomes, not conflicted white papers, hype, or hearsay.

RESTORE, REVIVE, REGENERATE™ — JUVENTIX REGENERATIVE MEDICAL

Want more information?
• Get In Touch Here  → https://juventix.com/provider/
• Technical/scientific questions → hello@juventix.com | 866-693-4777

Feel free to share this summary with colleagues who are still using sodium‑citrate kits.

About the Author: ⚕️ Lance Liberti, MBA, BCPA is a nationally recognized healthcare consultant and new patient marketing professional with more than two decades of practical experience in the field. His experience spans multiple areas of practice including non-surgical spinal decompression, medically supervised weight loss, aesthetic medicine, and non-operative extremity pain management. The president and CEO of Integrative Practice Solutions, Inc and Juventix Regenerative Medical Mr. Liberti specializes in assisting health and wellness professionals to integrate boutique medical services into their practices to offer non-surgical solutions to those suffering from various degenerative musculoskeletal conditions. To learn more about Mr. Liberti’s extensive experience and see examples of his work products view his LinkedIn profile here: www.linkedin.com/in/lanceliberti

Bibliography

1. Zimmer Biomet. ACD‑A Anticoagulant Citrate Dextrose Solution—Product Page. (accessed 2025). https://www.zimmerbiomet.com/en/products-and-solutions/products/pharmaceuticals/acd-a.html
2. U.S. FDA. Sodium Citrate 4 % w/v Anticoagulant Solution USP—Package Insert. (BA 125608). https://www.fda.gov/media/114460/download
3. Citra Labs. ACD‑A Anticoagulant Citrate Dextrose Solution, Solution A, USP—IFU. 2020.
4. Runels C. Clinical Newsletter & Video Transcript. April 2025.
5. do Amaral RJ et al. “Platelet‑rich plasma obtained with different anticoagulants and their effect on platelet numbers and MSC behaviour in vitro.” Stem Cells Int. 2016.
6. Görgü M, Gökkaya A, Doğan A. “Comparison of two anticoagulants for pain associated with platelet‑rich plasma injections.” Aesthetic Plast Surg. 2020;44:955‑961. https://pubmed.ncbi.nlm.nih.gov/31722064/
7. Oneto P et al. “Anticoagulants interfere with the angiogenic and regenerative responses mediated by platelets.” Front Bioeng Biotechnol. 2020. https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2020.00223/full
8. Pignatelli P, Pulcinelli FM, Ciatti F, Pesciotti M, Ferroni P, Gazzaniga PP.
   Effects of storage on in vitro platelet responses: comparison of ACD‑ and sodium‑citrate–anticoagulated samples. Journal of Clinical Laboratory Analysis. 1996;10(3):134‑139.doi:10.1002/(SICI)1098‑2825(1996)10:3<134::AID‑JCLA4>3.0.CO;2‑B. PMID: 8731500. Available at: https://pubmed.ncbi.nlm.nih.gov/8731500/
9. Lei H, Gui L, Xiao R. The effect of anticoagulants on the quality and biological efficacy of platelet‑rich plasma. Clinical Biochemistry. 2009;42(13‑14):1452‑1460. doi:10.1016/j.clinbiochem.2009.06.012. Available at: https://www.sciencedirect.com/science/article/pii/S0009912009002677

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