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Submitted:
19 May 2023
Posted:
22 May 2023
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Materials and trademarks | Hemostatic mechanism | Characteristics | Ref. |
---|---|---|---|
Chitosan-based materials ChitoFlex, Axiostat, PosiSep X, Celox, TraumaStat, HemCon. |
Positive surface charge enables it to bind with negatively charged blood components, promoting platelet activation and agglutination of blood proteins to facilitate fibrin clot formation, while also forming a strong physical barrier that adheres to wet tissues and seals wounds. |
Biocompatible, biodegradable, antibacterial ability, stimulatory effect on tissue regeneration, hemostatic effect, cost-effective, easy to store and long shelf-life; suitable for patients with coagulopathy, although it may not be entirely effective in extensive bleeding wounds. |
[33,34,35,36,37] |
Cellulose-based materials BloodSTOP, WoundClot, Surgicel, Suntouch, ActCel. |
Absorbs fluids, forms a physical barrier to prevent blood loss, exhibits anti-microbial activity, is bioabsorbable, and aids clotting by binding to calcium ions, initiating the clotting cascade through contact activation and decreasing pH at the wound site, leading to platelet activation and aggregation. |
Appropriate for achieving hemostasis in cases of capillary, arteriolar, venous, and bone bleeding, and is also biocompatible, non-immunogenic, and bactericidal, conforming well to the wound site. However, it may not be effective in managing severe bleeding. | [2,38,39,40,41] |
Starch-based materials PerClot, EndoClot |
Absorbs water from the blood, leading to the formation of a gel-like matrix that can adhere to tissue and promote the aggregation of platelets and activation of clotting factors, ultimately resulting in the formation of a stable fibrin clot that can help to stop bleeding. | Reduces bleeding and the need for transfusions, minimizes the risk of blood infections and has no known immune or allergic reactions or toxic side effects. Should not be used in blood vessels to avoid the risk of embolism and is suitable for minor injuries. It is easy to use, lightweight, has a long shelf life, is inexpensive. |
[42,43,44,45,46,47] |
Collagen-based materials Avitene, Helitene, Hemopad, Helistat, Collastat, Instat, CoStasis, D-stat. |
Forms a physical matrix, triggers the process of coagulation cascade and induces the activation of platelets, leading to the release of clotting factors like thrombin and fibrinogen. | Promotes tissue regeneration and repair, and possesses characteristics such as biocompatibility, cell adhesion, biodegradability, non-toxicity, and low antigenicity. Effective in heparinized patients, not suitable for use in patients with thrombocytopenia. |
[2,20,33,48,49] |
Gelatin-based materials Gelfoam, Surgifoam, Gelfilm, Gelita-spon. |
Triggers the activation and aggregation of platelets, expedites the formation of clots, and provides structural support to the clot formed by enhancing thrombin generation and subsequently propagating the coagulation cascade. | Applicable for treating various types of wounds and injuries, but caution must be taken when used in restricted areas or near nerve structures due to the potential risk of compressive complications. It is a cost-effective solution that remains stable at room temperature, non-toxic, and non-antigenic. Furthermore, it has a strong adsorption capability, can stick to the wound surface, and can increase its volume up to twice its original size by absorbing fluids. | [23,50,51,52,53] |
Fibrin-based materials Artiss, Tissel, Evicel, Tissucol, TachoSil. |
Major protein component of blood clots, is formed as the final step in the coagulation cascade, serving as a scaffold for tissue repair and providing cues for cell behavior during injury healing. | Exhibits excellent hemostatic and adhesive properties, biocompatibility, and can be used for severe bleeding and patients with coagulation disorders but is not recommended for application on blood vessels. It also aids in tissue regeneration following injury due to its fast polymerization dynamics and ease of tunability. | [54,55,56,57] |
Polycyanoacrylates-based materials Dermabond, Omnex, Glubran, Histoacryl, GLUture. |
Rapidly polymerize upon contact with fluids to create a mechanical barrier or plug that occludes the bleeding vessel or tissue, resulting in hemostasis. | Presents bactericidal and bacteriostatic effects, non-toxic, non-carcinogenic, and good histocompatibility, with considerable hemostatic ability and can be applied in anastomosis, wound hemostasis, wound adhesion, and tendon repair, however, it may result in vascular embolization and release of toxic substances. | [52,58,59,60] |
PEG-based materials Coseal |
Upon contact with tissue fluids to form a gel-like matrix, which adheres to the tissue and provides a mechanical barrier to prevent bleeding. | Favorable biocompatibility, minimal cytotoxicity, and excellent hemostatic properties, commonly utilized in surgical settings to reduce bleeding and facilitate wound healing with a low occurrence of unfavorable consequences. | [48,61,62,63,64] |
Polyurethane-based materials Bioclusive, Opsite Flexigrid, Tegaderm, Allevyn, Tegaderm (3M Science), TissuGlu (Cohera Medical, Inc.), ResQFoam (Arsenal Medical, Inc.), Nanosan-Sorb (SNS Nano Fiber Technology) |
It triggers activation and aggregation of thrombocytes, initiating both coagulation cascade. |
Polyurethane dressings can maintain a moist wound environment by allowing the transmission of moisture, oxygen, and air while blocking fluids and bacteria, and provide thermal insulation, promoting autolytic debridement; their high absorbency is due to a hydrophilic contact surface, microporous foam, and hydrophobic backing. Maintains its shape and firmness when exposed to blood, | [51,65,66,67] |
Zeolite and kaolin powder based materials Quikclot, Woundstat Combat Gauze |
Has a hygroscopic action, which allows it to quickly absorb water from blood to concentrate coagulation factors; it can also release Ca++ in blood and activate FXII to trigger the intrinsic coagulation pathway, and potentially induce contact activation of platelets. | Ease of use, stability, no biological toxicity or disease transmission, provide deep tissue access, are inert, and do not elicit an immune response. Not bioabsorbable and are less effective for arterial bleeding or coagulopathic patients. Their success is dependent on the patient's blood clotting activity. May cause thrombotic complications if particles enter the bloodstream. |
[26,48,68,69,70] |
PEG – Polyethylene glycol; PU – Polyurethane; FXII – Coagulation factor XII; |
Forms | Composition | Characteristics | Ref. |
---|---|---|---|
Dressing | CS, Aluminum chloride | The microporous structure of the dressing is irregular, which allows it to absorb the maximum amount of blood and promote clot formation. | [35] |
Carrageenan, CS | The composite dressing's greater swelling, larger surface area, and mesoporous structure result in superior hemostatic activity by promoting increased adhesion of blood cells and platelets. | [99] | |
CS, Calcium Alginate | Biocompatibility, antibacterial, moisture retention, healing promotion, and noncytotoxicity characteristics make chitosan-calcium alginate dressing a superior option for wound care. | [100] | |
Hydrogel | CS, PEG | The combination of biodegradability, self-adhesiveness, self-healing ability, stretchability, antibacterial properties, and biocompatibility makes it a promising material for emergency hemostasis, particularly for joint and limb injuries. The hydrogel showed strong adhesion to various substrates (PTFE, pigskin, and glass tubes) and provided long-term stability when applied to bleeding wounds in both static and dynamic humid environments. | [101] |
Hydroxybutyl-functionalized CS | The material possesses thermosensitive characteristics, strong adhesion ability, effective hemostasis, appropriate mechanical properties, self-healing capability, easy removal as needed, antioxidant properties, as well as photothermal and intrinsic antibacterial activity. | [102] | |
FCMCS, PDA, PAM | The hydrogel exhibited a variety of functions including tissue adhesion, biocompatibility, self-healing, and antibacterial properties. It also maintained its mechanical characteristics while offering broad-spectrum antibacterial activity. | [103] | |
CMCS, OHA | The material exhibits favorable biodegradability and biosafety profiles, and possesses strong hemostatic and sealing capabilities, making it a promising candidate for clinical hemostatic sealant applications. | [104] | |
Sponge | Cs, AgNPs | The chitosan/Ag nanocomposite sponges demonstrated outstanding antibacterial activity against Staphylococcus aureus and E. coli in the antibacterial test. They also displayed good mechanical properties and noncytotoxicity, with cell viability values exceeding 90%. | [105] |
CS, Cellulose | The sponge demonstrates favorable biocompatibility and hemostatic capability, making it a promising option for prompt hemostasis in cases of severe bleeding. | [106] | |
CS/PVA-PD-FeO NPs | The sponge demonstrated high porosity and water absorption properties, as well as significant antibacterial activity. It facilitated gaseous exchange, absorbed wound exudate, and inhibited microbial growth in diabetic wounds. Therefore, it can be inferred that the chitosan composite sponge's antioxidant, antidiabetic, and antibacterial properties can contribute to the healing of diabetic wounds. | [107] | |
CS/ AgNPs /Alginate | The material demonstrated notable absorbency and a significant antimicrobial impact, particularly in assays involving Bacillus cereus and Staphylococcus aureus. | [108] | |
CS, SIP | The material exhibits a strong ability to absorb fluids, as well as significant procoagulant effects, making it effective in promoting wound healing. | [109] | |
CS – Chitosan; PEG – Polyethylene glycol; CMCS – Carboxymethyl chitosan; PDA – Polydopamine; PAM – Polyacrylamide; FCMCS – Fungal mushroom-derived carboxymethyl chitosan; OHA – Oxidized hyaluronic acid; AgNPs – Silver nanoparticles; PD – aqueous leaves extract of Pinus densiflora; FeO – Iron oxide; PVA – Poly vinyl alcohol; SIP – Squid ink polysaccharide. |
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