Tranexamic acid-loaded starch hemostatic microspheres

Tranexamic acid loaded in a physically crosslinked trilaminate dressing for local hemorrhage control: Preparation, characterization, and in-vivo assessment using two different animal models

This work aimed at formulating a trilaminate dressing loaded with tranexamic acid. It consisted of a layer of 3 % sodium hyaluronate to initiate hemostasis. It was followed by a mixed porous layer of 5 % polyvinyl alcohol and 2 % kappa-carrageenan. This layer acted as a drug reservoir that controlled its release. The third layer was 5 % ethyl cellulose backing layer for unidirectional release of tranexamic acid towards the wound. The 3 layers were physically crosslinked by hydrogen bonding as confirmed by Infrared spectroscopy. Swelling and release studies were performed, and results proposed that increasing number of layers decreased swelling properties and sustained release of tranexamic acid for 8 h. In vitro blood coagulation study was performed using human blood and showed that the dressing significantly decreased coagulation time by 70.5 % compared to the negative control. In vivo hemostatic activity was evaluated using tail amputation model in Wistar rats. Statistical analysis showed the dressing could stop bleeding in a punctured artery of the rat tail faster than the negative control by 59 %. Cranial bone defect model in New Zealand rabbits was performed to check for bone hemostasis and showed significant decrease in the hemostatic time by 80 % compared to the control.

Preparation and application of hemostatic microspheres containing biological macromolecules and others

Bleeding from uncontrollable wounds can be fatal, and the body's clotting mechanisms are unable to control bleeding in a timely and effective manner in emergencies such as battlefields and traffic accidents. For irregular and inaccessible wounds, hemostatic materials are needed to intervene to stop bleeding. Hemostatic microspheres are promising for hemostasis, as their unique structural features can promote coagulation. There is a wide choice of materials for the preparation of microspheres, and the modification of natural macromolecular materials such as chitosan to enhance the hemostatic properties and make up for the deficiencies of synthetic macromolecular materials makes the hemostatic microspheres multifunctional and expands the application fields of hemostatic microspheres. Here, we focus on the hemostatic mechanism of different materials and the preparation methods of microspheres, and introduce the modification methods, related properties and applications (in cancer therapy) for the structural characteristics of hemostatic microspheres. Finally, we discuss the future trends of hemostatic microspheres and research opportunities for developing the next generation of hemostatic microsphere materials.

Advances in haemostatic sponges: Characteristics and the underlying mechanisms for rapid haemostasis

In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk of complications and surgical failure. High expansion sponges are effective clinical practice for the treatment of wound bleeding (irregular/deep/narrow) that are caused by capillaries, veins and even arterioles as they possess a high liquid absorption ratio so can absorb blood platelets easily in comparison with traditional haemostasis treatments, which involve compression, ligation, or electrical coagulation etc. When in contact with blood, haemostatic sponges can cause platelet adhesion, aggregation, and thrombosis, preventing blood from flowing out from wounds, triggering the release of coagulation factors, causing the blood to form a stable polymerized fibre protein, forming blood clots, and achieving the goal of wound bleeding control. Haemostatic sponges are found in a variety of shapes and sizes. The aim of this review is to facilitate an overview of recent research around haemostatic sponge materials, products, and technology. This paper reviews the synthesis, properties, and characteristics of haemostatic sponges, together with the haemostasis mechanisms of haemostatic sponges (composite materials), such as chitosan, cellulose, gelatin, starch, graphene oxide, hyaluronic acid, alginate, polyethylene glycol, silk fibroin, synthetic polymers silver nanoparticles, zinc oxide nanoparticles, mesoporous silica nanoparticles, and silica nanoparticles. Also, this paper reviews commercial sponges and their properties. In addition to this, we discuss various in-vitro/in-vivo approaches for the evaluation of the effect of sponges on haemostasis.

Chitosan Lactate Particles for Non-Compression Hemostasis on Hepatic Resection

The liver is the most complex vascular anatomy of all human organs, with extremely rich blood flow and fragile texture. Massive liver bleeding usually occurs after traumatic liver injury, causing severe systematic issues. Thus, bleeding control is critical in hindering mortality rates and complications in patients. In this study, non-compression hemostasis materials based on chitosan lactate particles (CLP) were developed for handling liver bleeding after injuries. CLP showed good blood biocompatibility and antibacterial performance against S. aureus. Taking advantage of the vital capacity of CLP to promote red blood cell and platelet adhesion, CLP exhibited in vivo homeostasis properties as non-compression hemostasis materials for traumatic liver injury, both in SD rats, New Zealand rabbits, or in beagles. Whereas CLP has better hemostasis than the commercial hemostatic agent Celox™.

Diatomite hemostatic particles with hierarchical porous structure for rapid and effective hemostasis

The development of fast, safe and effective hemostatic materials is crucial for pre-hospital first aid. In this study, diatomite hemostatic granules (Dhp) were developed by rotating granulation method using silica sol as binder. During rotating granulation process, the Pre-Dhp were prepared by rolling snowball effect, in which nano-silica in silica sol uniformly distributed on the surface of diatomite and polymerized through hydrogen bond to produce strong adhesion. After high-temperature calcination, the hydrogen bond transformed to silica oxygen bond and the three-dimensional gel network formed by silica sol was destroyed to exposed the pores of diatomite. Dhp retained the porous structure of diatomite with hierarchical porous structure (from nano to micro scale). Dhp could quickly adsorb the tangible components in the blood, exhibited rapid hemostatic ability (clotting time was shortened by 43 % than that of control group), and good biocompatibility (hemolysis rate < 7 %, no cytotoxicity). Dhp residue was not found in the wound of rat tail amputation model, indicating that the adhesion of silica sol and high-temperature curing treatment enhanced the stability of Dhp and reduced the hidden danger of micro thrombosis caused by residual substances entering blood vessels. Our study proved that Dhp prepared by silica sol bonding and rotary granulation was excellent hemostatic material with non-toxic side effects and rapid coagulation promotion.

Hemostatic Alginate/Nano-Hydroxyapatite Composite Aerogel Loaded with Tranexamic Acid for the Potential Protection against Alveolar Osteitis

Wound control in patients on anticoagulants is challenging and often leads to poor hemostasis. They have a higher tendency to develop alveolar osteitis after tooth extraction. The application of a hemostatic dressing that has a high absorbing capacity and is loaded with an antifibrinolytic drug could help in controlling the bleeding. Alginate/nano-hydroxyapatite (SA/Nano-HA) composite aerogels loaded with tranexamic acid (TXA) were prepared. Nano-HA served as a reinforcing material for the alginate matrix and a source of calcium ions that helps in blood clotting. It influenced the porosity and the water uptake capacity. TXA release from SA/Nano-HA aerogels showed a biphasic profile for up to 4 h. Blood coagulation studies were performed on human whole blood. The TXA-loaded aerogel significantly reduced the clotting time by 69% compared to the control (p < 0.0001). Recalcification time was significantly reduced by 80% (p < 0.0001). Scanning electron microscopy analysis revealed the porous nature of the aerogels and the ability of the optimum aerogel to activate and adhere platelets to its porous surface. The cell migration assay showed that there was a delay in wound healing caused by the TXA aerogel compared to the control sample after treating human fibroblasts. Results suggest that the developed aerogel is a promising dressing that will help in hemostasis after tooth extraction.

Design of biopolymer-based hemostatic material: Starting from molecular structures and forms

Uncontrolled bleeding remains as a leading cause of death in surgical, traumatic, and emergency situations. Management of the hemorrhage and development of hemostatic materials are paramount for patient survival. Owing to their inherent biocompatibility, biodegradability and bioactivity, biopolymers such as polysaccharides and polypeptides have been extensively researched and become a focus for the development of next-generation hemostatic materials. The construction of novel hemostatic materials requires in-depth understanding of the physiological hemostatic process, fundamental hemostatic mechanisms, and the effects of material chemistry/physics. Herein, we have recapitulated the common hemostatic strategies and development status of biopolymer-based hemostatic materials. Furthermore, the hemostatic mechanisms of various molecular structures (components and chemical modifications) are summarized from a microscopic perspective, and the design based on them are introduced. From a macroscopic perspective, the design of various forms of hemostatic materials, e.g., powder, sponge, hydrogel and gauze, is summarized and compared, which may provide an enlightenment for the optimization of hemostat design. It has also highlighted current challenges to the development of biopolymer-based hemostatic materials and proposed future directions in chemistry design, advanced form and clinical application.

•

Biopolymers possess sound biocompatibility, biodegradability and bioactivity for the design of hemostatic materials.

•

Molecular structure designs including component and chemical modification are summarized from a microscopic perspective.

•

Design of various forms of hemostatic materials is discussed and compared synthetically from a macroscopic perspective.

Iota-carrageenan/xyloglucan/serine powders loaded with tranexamic acid for simultaneously hemostatic, antibacterial, and antioxidant performance

This study sought to prepare powder hemostats based on iota-carrageenan (ιC), xyloglucan (XYL), l-serine (SER), and tranexamic acid (TA). The powder form was chosen because it enables the hemostat to be used in wounds of any shape and depth. The powder hemostats showed irregular shapes and specific surface areas ranging from 34 to 46 m²/g. Increasing TA amount decreases the specific surface area, bulk density, water and blood absorption, and the antibacterial activities of the powder hemostats, but not the water retention ability. Conversely, in vitro biodegradation was positively impacted by increasing the TA content in the powder hemostats. In both the in vitro and in vivo tests, powder hemostats showed reduced bleeding time, significant adhesion of red blood cells, great hemocompatibility, moderate antioxidant activity, and high biocompatibility. These findings shed new light on designing powder hemostats with intrinsic antibacterial and antioxidant activity and excellent hemostatic performance.

Tranexamic acid-loaded hemostatic nanoclay microsphere frameworks

Fast acting topical hemostatic agents play a key role in hemorrhage control. Retarding fibrinolysis is also critical in improving coagulation, thereby expanding chances of survival. The purpose of the present work was to investigate the physical properties, loading capacity and hemostatic efficacy of newly developed nanoclay microsphere frameworks (NMFs) loaded with tranexamic acid (TA), as antifibrinolytic agent. Nanoclay compositions were prepared with increasing levels of TA. Results showed that TA was successfully incorporated into the nanoclay structure and released when solvated with ethanol. Both doped and undoped NMFs significantly decreased activated partial thromboplastin time and increased clot stiffness, which was attributed to significantly thinner fibrin fibers and a denser clot structure.

Hemostatic biomaterials to halt non-compressible hemorrhage

Non-compressible hemorrhage is an unmet clinical challenge, which occurs in inaccessible sites in the body where compression cannot be applied to stop bleeding. Current treatments reliant on blood transfusion are...

Recent advances in materials for hemostatic management

Traumatic hemorrhage can be a fatal event, particularly when large quantities of blood are lost in a short period of time. Therefore, hemostasis has become a crucial part of emergency treatment. For small wounds, hemostasis can be achieved intrinsically depending on the body's own blood coagulation mechanism; however, for large-area wounds, particularly battlefield and complex wounds, materials delivering rapid and effective hemostasis are required. In parallel with the constant progress in science, technology, and society, advances in hemostatic materials have also undergone various iterations by integrating new ideas with old concepts. There are various natural and synthetic hemostatic materials, including hemostatic powders, adhesives, hydrogels, and tourniquets, for the treatment of severe external trauma. This review covers the differences among the currently available hemostatic materials and comprehensively describes the hemostatic effects of different materials based on the underlying mechanisms. Finally, solutions for current issues related to trauma bleeding are discussed, and the prospects of hemostatic materials are proposed.

Facile and green approach towards biomass-derived hydrogel powders with hierarchical micro-nanostructures for ultrafast hemostasis

Although a series of biomass-derived hemostats has been developed, the desire for green-prepared hemostatic materials with biosafety has not decreased. Herein, we constructed porous carboxymethyl chitosan/sodium alginate/Ca(OH)₂ powders (PCSCPs) with suitable adaptability for instant control of irregular hemorrhage via a facile and green approach. By one-pot chemical crosslinking of carboxymethyl chitosan and sodium alginate, hydrogels were formed and immediately ionically cross-linked along with the generation of Ca(OH)₂ to prepare PCSCPs. As hydrogel powders, PCSCPs with abundant hydrophilic carboxymethyl groups and porous hierarchically micro-nanostructures displayed a high water absorption ratio of over 1600%. The PCSCPs were confirmed with favorable hemocompatibility, non-cytotoxic effects and excellent degradability. Hemostasis assays in vitro showed that PCSCPs possessed an outstanding property of platelet activation and red blood cell aggregation. The PCSCPs effectively shortened the hemostatic time and blood loss to ca. 50% in rodent bleeding models compared with medical gauze and commercial chitosan-based hemostats. Furthermore, a mouse subcutaneous implantation model demonstrated an ignorable inflammation response and potential tissue repair capability of PCSCPs. It's believed that green-prepared and biomass-derived PCSCPs are feasible biomedical hemostatic materials in view of engineering and provide a promising platform to design hemostats in prehospital management and clinical settings.

A composite sponge based on alkylated chitosan and diatom-biosilica for rapid hemostasis

Rapid control of bleeding is of great significance in military trauma and traffic accidents. In this study, alkylated chitosan (AC) and diatom biosilica (DB) were combined to develop a safe and effective hemostatic composite sponge (AC-DB sponge) for hemorrhage control. Due to the procoagulant chemical structure of AC-DB sponge, it exhibited rapid hemostatic ability in vitro (clotting time was shortened by 78% than that of control group), with favorable biocompatibility (hemolysis ratio < 5%, no cytotoxicity). The strong interface effect between AC-DB sponge and blood induced the erythrocyte and platelets activation, deformation and aggregation, intrinsic coagulation pathway activation, resulting in significant coagulation acceleration. AC-DB sponge had excellent performance in in vivo assessments with shortest clotting time (106.2 s) and minimal blood loss (328.5 mg). All above results proved that AC-DB sponge had great potential to be a safe and rapid hemostatic material.

Chitosan/Diatom-Biosilica Aerogel with Controlled Porous Structure for Rapid Hemostasis

Uncontrolled hemorrhage is the main reason of possible preventable death after accidental injury. It is necessary to develop a hemostatic agent with rapid hemostatic performance and good biocompatibility. In this study, a chitosan/diatom-biosilica-based aerogel is developed using dopamine as cross-linker by simple alkaline precipitation and tert-butyl alcohol replacement. The chitosan/diatom-biosilica aerogel exhibits favorable biocompatibility and multiscale hierarchical porous structure (from nanometer to micrometer), which can be controlled by the concentration of tert-butyl alcohol. The displacement of tert-butyl alcohol can keep the porosity of diatom-biosilica in aerogel and give it large surface with efficient water absorption ratio. 30% tert-butyl alcohol replacement of aerogel possesses the largest surface area (74.441 m² g^-1 ), water absorption capacity (316.83 ± 2.04%), and excellent hemostatic performance in vitro blood coagulation (≈70 s). Furthermore, this aerogel exhibits the shortest clotting time and lowest blood loss in rat hemorrhage model. The strong interface effect between aerogel and blood is able to promote erythrocytes aggregation, platelets adhesion, and activation, as well as, activate the intrinsic coagulation pathway to accelerate blood coagulation. All the above results demonstrate that chitosan/diatom-biosilica aerogel has great potential to be a safe and rapid hemostatic material.

Hemostatic agents for prehospital hemorrhage control: a narrative review

Hemorrhage is the leading cause of preventable death in combat trauma and the secondary cause of death in civilian trauma. A significant number of deaths due to hemorrhage occur before and in the first hour after hospital arrival. A literature search was performed through PubMed, Scopus, and Institute of Scientific Information databases for English language articles using terms relating to hemostatic agents, prehospital, battlefield or combat dressings, and prehospital hemostatic resuscitation, followed by cross-reference searching. Abstracts were screened to determine relevance and whether appropriate further review of the original articles was warranted. Based on these findings, this paper provides a review of a variety of hemostatic agents ranging from clinically approved products for human use to newly developed concepts with great potential for use in prehospital settings. These hemostatic agents can be administered either systemically or locally to stop bleeding through different mechanisms of action. Comparisons of current hemostatic products and further directions for prehospital hemorrhage control are also discussed.

In-vitro and in-vivo evaluation of modified sodium starch glycolate for exploring its haemostatic potential

The control of blood flow from breached blood vessels during surgery or trauma is challenging. With the existing treatment options being either expensive or ineffective, the development of a haemostat that overcome such drawbacks would be beneficial. With an aim to develop an ideal haemostat, the potential of sodium starch glycolate (SSG), a commonly used pharmaceutical disintegrant was modified to obtain porous microparticles (pSSG). The biodegradability, cyto-compatibility and haemo-compatibility of the modified particles were confirmed using appropriate studies. In comparison to starch and SSG, the irregular shaped pSSG demonstrated spontaneous and significant fluid absorption (3500+500 %) and formed a physical barrier to blood flow. In addition, significant blood cells aggregation and platelet activation was observed in the modified micoparticles leading to rapid clot formation. In-vivo studies on liver and abdominal artery injury models in rats indicated the superior haemostatic potential of pSSG over SSG and starch. The results indicated that pSSG can be explored further in clinical evaluation as a hemostat.

Research status and development potential of composite hemostatic materials

Through the discussion of the coagulation mechanism of compositehemostatic materials, the future development potential of hemostatic materials is proposed.