Bactericidal Hemostatic Sponge: A Point of Care Solution to Combat Traumatic Injury

Uncontrollable haemorrhage and associated microbial contamination in the battlefield and civilian injuries pose a tremendous threat to healthcare professionals. Such traumatic wounds often necessitate an effective point-of-care solution to prevent the consequent morbidity owing to blood loss or haemorrhage. However, developing superior hemostatic materials with anti-infective properties remains a challenge. To address this, an injectable, cationic dextran-mesoporous silica nanoparticle-based bactericidal hemostatic sponge (BACSTAT) has been developed. A dual crosslinking approach is adopted through in situ covalent cross-linking through photo polymerization and silica nanoparticle-induced non-covalent interactions. This interconnected macroporous BACSTAT sponge has superior fluid absorption properties and fluid-induced rapid shape recovery of the sponge helps to seal the irregularly shaped wound. Furthermore, this sponge can stimulate a coagulation cascade for rapid blood clotting in mice femoral vein incision and liver puncture model. The optimum sponge exhibited potent antibacterial activity against wide-spectrum Gram-positive and Gram-negative pathogens. Notably, it is completely biocompatible with mammalian cells and mice skin. Significantly, this sponge reduces Pseudomonas aeruginosa burden >99% in mice subcutaneous infection model with substantially lessening inflammatory responses in infected tissues. Collectively, the optimized sponge bears immense potential to be developed as point-of-care solution for military and civilian traumatic injury.

Ultrafast Self-Gelling, Adhesive, Anti-Bacterial Coacervate-Based Powders for Enhanced Hemostasis and Wound Healing

Uncontrolled hemorrhage, especially in non-compressible and deep wounds, remains a critical issue in emergency and surgical care. Existing hemostatic powders often lack rapid gelation, mechanical robustness, and adequate adherence, increasing the risk of rebleeding under high-pressure blood flow. To address these limitations, PQPP, a novel self-gelling hemostatic material composed of polyacrylamide/quaternized chitosan coacervates and polydopamine nanoparticles is developed. PQPP can rapidly absorb blood within 2 s, undergoes in situ gelation, and forms a robust adhesive hydrogel to effectively seal wounds. Its efficacy stems from the electrostatic adsorption and catechol functional groups of polydopamine nanoparticles. Importantly, PQPP exhibits high burst pressure resistance, excellent blood cell aggregation capability, outstanding biocompatibility, and antibacterial properties. Comprehensive in vitro and in vivo studies, including cytotoxicity and blood compatibility tests, as well as trials in mouse liver, heart, and vascular injury models, demonstrate PQPP's superior hemostatic performance under high-pressure conditions without causing inflammation. With its rapid gelation, robust adhesion, and mechanical integrity, PQPP represents a promising hemostatic material for immediate wound management in surgical and emergency applications.

Self-expanding cellulose sponge with enhanced hemostatic ability by tannic acid/metal ion composite coating for highly effective hemostasis of difficult-to-control bleeding wounds

Refractory bleeding presents a critical, life-threatening challenge, and the goal of medical professionals and researchers has always been to achieve safe and effective hemostasis for bleeding wounds. In this study, we utilized the benefits of a self-expanding cellulose sponge to control incompressible bleeding, which is achieved this by creating a tannic acid/metal ion coating on the surface and within the pores of the sponge to improve its hemostatic effectiveness. The effects of various types and concentrations of metal ions (calcium, magnesium, iron, and zinc) on hemostatic efficiency and biosafety is systematically investigated. The results from bacteriostasis and in vitro coagulation experiments identified 0.3 wt% Fe3+ as the optimal metal ion coating. Scanning electron microscope energy spectrum analysis confirmed the uniform distribution of Fe3+ within the cellulose sponge. Furthermore, the in vivo and in vitro results demonstrated that the prepared tannic acid/Fe3+ coated composite hemostatic sponge exhibits excellent coagulation ability and biocompatibility. Both the bleeding time and theblood loss in two bleeding models are significantly reduced, showing promising potential for treating extensive surface bleeding and deep penetrating wounds. Furthermore, the straightforward preparation method for this composite hemostatic sponge facilitates additional research towards market application.

Rapid preparation of bioadhesive hydrogels containing catechol moieties at room temperature with reproducible adhesion to wet tissues, antimicrobial, antioxidant capacity for noncompressive hemostasis

In order to cope with the massive tissue bleeding caused by sudden trauma and the demand for bioengineering materials with adjustable wet adhesion properties, this study formed the first layer of network by adding galactomannan (GG) and collagen (Col) structure, and then use the Fe3+-urushiol (UH) redox system to activate free radicals to initiate the polymerization of acrylic acid (AA) to quickly form an interpenetrating double network hydrogel. The cis hydroxyl group in GG and the hydroxyl group of UH form dynamic covalent borate ester bonds with borate ions in the borax solution, and use their responsiveness to pH to control the catechol group to achieve controllable adhesion. UH and Fe3+ endowed the hydrogel with excellent antibacterial ability, while adding Col enhanced the mechanical properties of the hydrogel. The elastic modulus and toughness increased from 4.32 kPa and 92.9 kJ/m3 to 18.90 kPa and 264.54 kJ/m3. In addition, due to the joint action of UH and Col, the hydrogel dressing can achieve rapid hemostasis within 20 s. In short, this hydrogel dressing has good biocompatibility, inherent antibacterial ability, adjustable moist tissue adhesion properties and rapid hemostatic ability, and is expected to become a candidate for wound hemostasis dressing.

Serotonin-functionalized starch-based hemostatic sponges enhance platelet activation in the management of non-compressible hemorrhage

Massive hemorrhage poses a serious threat to human health and even life. Access to rapid and potent hemostatic materials is crucial for lowering mortality rates. Starch-based materials exhibit good biocompatibility and are extensively utilized in hemostatic. However, existing starch-based hemostatic products suffer from limited hemostatic efficacy. Serotonin, an indoleamine naturally occurring in the human body, is recognized for its potent platelet-activating properties. Therefore, this study focused on enhancing the procoagulant activity of starch by incorporating serotonin into the starch backbone via esterification and amidation reactions, yielding a novel serotonin-loaded starch-based hemostatic sponge (SLS sponge). The SLS sponges featured exceptional porosity (≥80 %) and water absorption capacity (≥2000 %), which rapidly initiated the coagulation cascade reaction, promoted the adhesion and aggregation of red blood cells and platelets, and intensified platelet activation. This multifaceted approach synergistically enhanced hemostasis via both active and passive coagulation mechanisms. Notably, the SLS sponges adhered firmly to the wound surfaces without pressure. Compared with gelatin sponges, the SLS sponges significantly reduced blood loss by approximately 40.5 % and shortened the time to achieve hemostasis by approximately 28.9 %. These findings indicate that the newly developed SLS sponges are a promising active hemostatic material, particularly effective in managing non-compressible hemorrhages.

A hemoadhican-based sponge with anti-heparin interference for treating uncontrollable massive hemorrhage

Hemoadhican (HD) is an exopolysaccharide with a branched structure that has been reported for its high hemostatic ability. In this study, a HD-based hemostatic sponge was prepared through ultrasonic dissolution and freeze-drying without using any cross-linking agent. The sponge could spontaneously cross-link using hydrogen bonds to form adhesive mud within 3 s upon contact with blood. This sponge-mud mixture adhered tightly to the wound tissue, forming a pressure-resistant physical barrier that captures and locks in blood cells and platelets. Simultaneously, the hydrophobic methyl groups of HD sponges repel blood inwardly, effectively sealing the wound. The brush-like structure of HD molecules was suspected to penetrate wet tissues through topological entanglement, thereby enhancing wet adhesion. Compared with gauze and gelatin sponges, HD sponges achieved more effective hemostasis in animal models using rat and rabbit femoral arteries. In particular, HD sponges showed excellent hemostasis in heparin-induced hemorrhage models in mice and pigs. The in vivo experiment demonstrated the excellent biosafety of the HD sponge. Conclusively, the HD sponge is a safe and efficient rapid hemostatic material that is expected to become an alternative material for clinical hemostatic procedures.

A novel macroporous carboxymethyl chitosan/sodium alginate sponge dressing capable of rapid hemostasis and drug delivery

Carboxymethyl chitosan (CMCS) and sodium alginate (SA), which are excellent polysaccharide-based hemostatic agents, are capable of forming polyelectrolyte complexes (PEC) through electrostatic interactions. However, CMCS/SA PEC sponges prepared by the conventional sol-gel process exhibited slow liquid absorption rate and poor mechanical properties post-swelling. In this work, a novel strategy involving freeze casting followed by acetic acid vapor treatment to induce electrostatic interactions was developed to fabricate novel PEC sponges with varying CMCS/SA mass ratios. Compared to sol-gel process sponge, the novel sponge exhibited a higher density of electrostatic interactions, resulting in denser pore walls that resist re-gelation and swelling according to FTIR, XRD, and SEM analyses. Additionally, the liquid absorption kinetics, as well as compression and tension tests, demonstrated that the novel sponge had significantly improved rapid blood absorption capacity and mechanical properties. Furthermore, in vitro coagulation and drug release studies showed that the novel sponge had a lower blood clotting index and clotting time, along with a slower drug release rate after loading with berberine hydrochloride, showcasing its potential as a rapid hemostatic dressing with controlled drug release capabilities.

The Application of Regenerated Silk Fibroin in Tissue Repair

Silk fibroin (SF) extracted from silk is non-toxic and has excellent biocompatibility and biodegradability, making it an excellent biomedical material. SF-based soft materials, including porous scaffolds and hydrogels, play an important role in accurately delivering drugs to wounds, creating microenvironments for the adhesion and proliferation of support cells, and in tissue remodeling, repair, and wound healing. This article focuses on the study of SF protein-based soft materials, summarizing their preparation methods and basic applications, as well as their regenerative effects, such as drug delivery carriers in various aspects of tissue engineering such as bone, blood vessels, nerves, and skin in recent years, as well as their promoting effects on wound healing and repair processes. The authors expect SF soft materials to play an important role in the field of tissue repair.

Development of Polyphosphate/Nanokaolin-Modified Alginate Sponge by Gas-Foaming and Plasma Glow Discharge Methods for Ultrarapid Hemostasis in Noncompressible Bleeding

Effective bleeding management strategies in uncontrollable and noncompressible massive hemorrhage are becoming important in both clinical and combat situations. Here, a novel approach was developed to create a superporous and highly absorbable hemostatic sponge through a facile chemical gas-foaming method by cross-linking long-chain polyphosphate along with nanokaolin and Ca2+ in an alginate structure to synergistically activate the coagulation pathway. Natural kaolin obtained from the Marand mine in East Azarbaijan was converted into pseudohexagonal-shaped kaolin nanoparticles (30 to 150 nm) using ball milling followed by a newly developed glow discharge plasma treatment method. The obtained ultralight sponges (>90% porosity) exhibit ultrarapid water/blood absorption capacity (∼4000%) and excellent shape memory, which effectively concentrates coagulation factors. The results of in vitro tests demonstrated that the proposed sponges exhibited enhanced blood clotting ability (BCI < 10%) and superior cohesion with red blood cells (∼100) and platelets (∼80%) compared to commercially available hemostatic products. The in vivo host response results exhibited biosafety with no systemic and significant local inflammatory response by hematological, pathological, and biochemical parameter assessments. In a rat femoral artery complete excision model, the application of alginate/k/polyp nanocomposite sponges resulted in a complete hemostasis time of 60 s by significant reduction of hemostasis time (∼6.7-8.3 fold) and blood loss (∼2-2.8-fold) compared to commercially available hemostatic agents (P < 0.001). In conclusion, distinct physical characteristics accompanied by unique chemical composition multifunctional sponges activate hemostasis synergistically by triggering the XII, XI, X, IX, V, and II factors and the contact pathway and have the ability of rapid hemostasis in noncompressible severe bleeding.

Silk Fibroin and Its Nanocomposites for Wound Care: A Comprehensive Review

For most individuals, wound healing is a highly organized, straightforward process, wherein the body transitions through different phases in a timely manner. However, there are instances where external intervention becomes necessary to support and facilitate different phases of the body's innate healing mechanism. Furthermore, in developing countries, the cost of the intervention significantly impacts access to treatment options as affordability becomes a determining factor. This is particularly true in cases of long-term wound treatment and management, such as chronic wounds and infections. Silk fibroin (SF) and its nanocomposites have emerged as promising biomaterials with potent wound-healing activity. Driven by this motivation, this Review presents a critical overview of the recent advancements in different aspects of wound care using SF and SF-based nanocomposites. In this context, we explore various formats of hemostats and assess their suitability for different bleeding situations. The subsequent sections discuss the primary causes of nonhealing wounds, i.e., prolonged inflammation and infections. Herein, different treatment strategies to achieve immunomodulatory and antibacterial properties in a wound dressing were reviewed. Despite exhibiting excellent pro-healing properties, few silk-based products reach the market. This Review concludes by highlighting the bottlenecks in translating silk-based products into the market and the prospects for the future.

Recent research advances in polysaccharide-based hemostatic materials: A review

Massive bleeding resulting from civil and martial accidents can often lead to shock or even death, highlighting the critical need for the development of rapid and efficient hemostatic materials. While various types of hemostatic materials are currently utilized in clinical practice, they often come with limitations such as poor biocompatibility, toxicity, and biodegradability. Polysaccharides, such as alginate (AG), chitosan (CS), cellulose, starch, hyaluronic acid (HA), and dextran, have exhibit excellent biocompatibility and in vivo biodegradability. Their degradation products are non-toxic to surrounding tissues and can be absorbed by the body. As a result, polysaccharides have been extensively utilized in the development of hemostatic materials and have gained significant attention in the field of in vivo hemostasis. This review offers an overview of the different forms, hemostatic mechanisms, and specific applications of polysaccharides. Additionally, it discusses the future opportunities and challenges associated with polysaccharide-based hemostats.

Synthesis and characterization of thermosensitive 2-hydroxypropyl-trimethylammonium chitin and its antibacterial sponge for noncompressible hemostasis and tissue regeneration

Noncompressible hemorrhage is a leading cause of preventable death in battlefield/civilian trauma. The development of novel injectable and biodegradable hemostatic sponges, with rapid shape recovery and excellent antibacterial activity that can control hemorrhage in noncompressible bleeding sites and promote in situ tissue regeneration is still urgently needed. In this study, thermo/pH sensitive 2-hydroxypropyl-trimethylammonium chitins (QCHs) with low degree of quaternization substitution (DS: 0.07-0.23) and high degree of acetylation (DA: 0.91-0.94) were synthesized homogeneously for the first time. Their chemical compositions including DS and DA were characterized accurately by proton NMR for the first time. High strength QCH based sponges with good water/blood absorbency, rapid shape recovery and good antibacterial activity were prepared without using any crosslinkers but only due to their thermosensitive property, since they are soluble at low temperature but insoluble at high temperature. Compared with commercial products, the QCH sponges with cationic groups had the stronger pro-coagulant ability, better hemostatic effect in normal/heparinized liver perforation and femoral artery models in rats and porcine subclavian arteriovenous resection model. Moreover, the porous structure and biodegradability of the QCH sponges could promote in situ tissue regeneration. Overall, the QCH sponges show great clinical translational potential for noncompressible hemorrhage and tissue regeneration.

Process optimization and character evaluation of Bletilla striata polysaccharide (BSP) and chitosan (CS) composite hemostatic sponge (BSP-CS)

Bletilla striata polysaccharide (BSP) and chitosan (CS) were chemically cross-linked using oxalyl chloride to prepare a composite hemostatic sponge (BSP-CS), and the process parameters were optimized using the Box-Behnken design (BBD) with response surface methodology. To optimize the performance of the hemostatic sponge, we adjusted the ratio of independent variables, the amount of oxalyl chloride added, and the freeze-dried volume. A series of evaluations were conducted on the hemostatic applicability of BSP-CS. The characterization results revealed that BSP-CS had a stable bacteriostatic effect on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa within 72 h, and the bacteriostatic rate was above 30%. The CCK-8 cytotoxicity test demonstrated that BSP-CS had a certain effect on promoting cell proliferation of L929 cells. In the mouse tail-cutting experiment, the hemostasis time of BSP-CS was 463.0±38.16 s, shortened by 91.3 s on average compared with 554.3±34.67 s of the gauze group. The blood loss of the BSP-CS group was 28.47±3.74 mg, which was 34.7% lower than that of the control gauze group (43.6±3.83 mg). In the in vitro coagulation experiment, the in vitro coagulation index of the BSP-CS group was 97.29%±1.8%, which was reduced to 8.6% of the control group. The CT value of the BSP-CS group was 240±15 s, which was 155 s lower than that of the gauze group (355±31.22 s). All characterization results indicate that BSP-CS is an excellent hemostatic material.

Recent research advances on polysaccharide-, peptide-, and protein-based hemostatic materials: A review

Hemorrhage is a potentially life-threatening emergency that can occur at any time or place. Whether traumatic, congenital, surgical, disease-related, or drug-induced, bleeding can lead to severe complications or death. Therefore, the development of efficient hemostatic materials is critical. However, the results and prognosis demonstrated by clinical means of hemostasis do not reach expectations. With the development of technology, novel hemostatic materials have been developed from polysaccharides (chitosan, hyaluronic acid, alginate, cellulose, cyclodextrins, starch, dextran, and carrageenan), peptides (self-assembling peptides), and proteins (silk fibroin, collagen, gelatin, keratin, and thrombin). These new materials exhibit high hemostatic efficacy due to the enhancement or interaction of various hemostatic mechanisms. The main forms include adhesives, sealants, bandages, hemostatic powders, and hemostatic sponges. This article introduces the clotting process and principles of hemostatic methods and reviews the research on polysaccharide-, peptide-, and protein-based hemostatic materials in the last five years. The design ideas and hemostatic principles of polysaccharide-, peptide-, and protein-based hemostatic materials are mainly introduced. Finally, we summarize material designs, advantages, disadvantages, and challenges regarding hemostatic materials.

Recent advances in the application of clay-containing hydrogels for hemostasis and wound healing

INTRODUCTION

Immediate control of bleeding and anti-infection play important roles in wound management. Multiple organ dysfunction syndrome and death may occur if persistent bleeding, hemodynamic instability, and hypoxemia are not addressed. The combination of clay and hydrogel provides a new outlet for wound hemostasis. In this review, the current research progress of hydrogel/clay composite hemostatic agents was reviewed.

AREAS COVERED

This paper summarizes the characteristics of several kinds of clay including kaolinite, montmorillonite, laponite, sepiolite, and palygorskite. The advantages and disadvantages of its application in hemostasis were also summarized. Future directions for the application of hydrogel/clay composite hemostatic agents are presented.

EXPERT OPINION

Clay can activate the endogenous hemostatic pathway by increasing blood cell concentration and promoting plasma absorption to accelerate the hemostasis. Clay is antimicrobial due to the slow release of metal ions and has a rich surface charge with a high affinity for proteins and cells to promote tissue repair. Hydrogels have some properties such as good biocompatibility, strong adhesion, high stretchability, and good self-healing. Despite promising advances, hydrogel/clay composite hemostasis remains a limitation. Therefore, more evidence is needed to further elucidate the risk factors and therapeutic effects of hydrogel/clay in hemostasis and wound healing.

Granular Hemostatic Composite of Alginate, Calcium, and Zinc for Rapid and Effective Management of Post-Traumatic Hemorrhage

Post-traumatic hemorrhage, which can result from accidents or battlefield injuries, is a significant global concern due to the high prehospital mortality rate. Substantial efforts have been made to develop hemostatic agents that can effectively reduce hemorrhage in the immediate aftermath of a traumatic event. The present study investigated the potential efficacy of Ca2+ and Zn2+ supplemented sodium alginate-based dry hemostatic particles (SA-CZ DHP) to manage excessive blood loss or post-traumatic hemorrhage. SA-CZ DHP were developed, followed by their physical and biochemical characterization, cytocompatibility and hemocompatibility testing, and critical evaluation of the hemostatic potential in vitro and in vivo. The safe SA-CZ DHP showed high absorption and accelerated blood clotting kinetics with reduced coagulation time (≈70%, p < 0.0001) in whole human blood, observed with insignificant hemolysis and uninterrupted RBC morphology. SA-CZ DHP significantly reduced the mean blood loss (≈90% in SD rats tail incision), and bleeding time (≈60% in BALB/c mice tail incision) was at par with commercially available Celox hemostatic granules. In conclusion, the biocompatible SA-CZ DHP exhibited rapid and effective management of excessive blood loss. It is also pertinent to note that the developed formulation could be a cost-effective alternative to its commercial counterparts.

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.

Development and biological evaluation of smart powder bandage for wound healing and dressing applications

Cutaneous wounds are one of the pressing concerns for healthcare systems globally. With large amounts of water, conventional hydrogels encounter obstacles in effectively delivering small molecules and peptides for wound healing. The surplus water content challenges the stability and sustained release of small molecules and peptides, diminishing their therapeutic efficacy. Our pioneering smart powder bandage, fabricated through freeze-drying, ensures a water content of <1 % during storage. Upon contact with wound exudate, it forms hydrogel layers, thereby optimizing the delivery of peptides. Tailored for thermosensitive peptides such as EGF, this strategy surmounts the limitations of conventional hydrogels, providing a robust platform for efficacious therapeutic delivery in wound healing applications. Developing multifunctional wound dressings with antibacterial, anti-inflammatory, hemostatic, and healing properties is essential to promote wound healing. Therefore, the current investigation reports the development of multifunctional EGF@Silnanom SPB with the above-mentioned properties to promote wound healing using silver nanomix (Silnanom) and bioactive epidermal growth factors (EGF) as active therapeutics. The characterization of smart powder bandage (SPB) revealed that Silnanom were homogeneously dispersed in the entangled polymer network. The multifunctional smart powder bandage exhibited high bacterial inhibition rates against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), and rigorous hemocompatibility, cell compatibility, and in vivo studies also confirmed its biocompatibility. Furthermore, multifunctional EGF@Silnanom SPB effectively reduced pro-inflammatory markers, enhanced collagen deposition, promoted angiogenesis, and accelerated wound healing in a full-thickness mouse wound model through the sustained release of Silnanom and EGF. Additionally, the results of hemostasis analysis on the tail amputation mouse model confirmed the hemostasis properties of the EGF@Silnanom SPB. Overall, the multifunctional EGF@Silnanom SPB shows promising potential for skin wound repair, offering a potent and effective solution to the challenges posed by conventional wound dressings.

Potential hemostatic compounds targeting urokinase plasminogen activator explored from three Euphorbiaceae species: Euphorbia maculata, Euphorbia humifusa, and Acalypha australis, with bio-affinity ultrafiltration UPLC-MS

INTRODUCTION

Numerous species of the Euphorbiaceae family, including Euphorbia maculata, Euphorbia humifusa, and Acalypha australis, have been used to manage bleeding disorders. However, few investigations have demonstrated their hemostatic potential, and their procoagulant compounds remain elusive.

OBJECTIVE

This study aimed to determine the most active procoagulant extracts from the three species' crude extract (CE) and fractions in order to screen out the active compounds and to analyze their possible mechanisms of action.

METHODS

An integrative approach, comprising prothrombin time and activated partial thromboplastin time evaluations and urokinase-type plasminogen activator (uPA) inhibitory assessment, followed by bio-affinity ultrafiltration paired with UPLC/QTOF-MS targeting uPA and docking simulations, was used.

RESULTS

The extracts with highest procoagulant activity were the CE for both E. maculata (EMCE) and E. humifusa (EHCE) and the n-butanol fraction (NB) for A. australis (AANB). The most promising ligands, namely, isoquercetin, orientin, rutin, and brevifolin carboxylic acid, were selected from these lead extracts. All of these compounds exhibited pronounced specific binding values to the uPA target and showed tight intercalation with the crucial side chains forming the uPA active pocket, which may explain their mode of action. The activity validation substantiated their hemostatic effectivity in inhibiting uPA as they had better inhibition constant (Ki) values than the reference drug tranexamic acid.

CONCLUSION

Collectively, the integrative strategy applied to these three species allowed the elucidation of the mechanisms underlying their therapeutic effects on bleeding disorders, resulting in the fast detection of four potential hemostatic compounds and their mode of action.

Progress and future prospects of hemostatic materials based on nanostructured clay minerals

The occurrence of uncontrolled hemorrhage is a significant threat to human life and health. Although hemostatic materials have made remarkable advances in the biomaterials field, it remains a challenge to develop safe and effective hemostatic materials for global medical use. Natural clay minerals (CMs) have long been used as traditional inorganic hemostatic agents due to their good hemostatic capability, biocompatibility and easy availability. With the advancement of science, technology and ideology, CM-based hemostatic materials have undergone continuous innovations by integrating new inspirations with conventional concepts. This review systematically summarizes the hemostatic mechanisms of different natural CMs based on their nanostructures. Moreover, it also comprehensively reviews the latest research progress for CM-based hemostatic hybrid and nanocomposite materials, and discusses the challenges and developments in this field.

Fabricating Oxidized Cellulose Sponge for Hemorrhage Control and Wound Healing

Uncontrolled hemorrhage and infection are the main reasons for many trauma-related deaths in both clinic and battlefield. However, most hemostatic materials have various defects and side effects, such as low hemostatic efficiency, poor biocompatibility, weak degradation ability, and lack of antimicrobial properties. Herein, an oxidized cellulose (OC) sponge with antibacterial properties and biosafety was fabricated for hemorrhage control and wound healing. The as-prepared OC sponges were prone to water triggered expansion and superabsorbent capacity, which could facilitate blood component concentration effectively. Importantly, they had significant biodegradability with little irritation to the skin. This hemostat could also reduce the plasma clotting time to 53.54% in vitro and demonstrated less blood loss than commercially available hemostatic agents (GS) in a mouse model of bleeding from liver defects. Furthermore, the biocompatibility antimicrobial properties and possible hemostatic mechanism of the OC sponge were also systematically evaluated. Importantly, the potential wound healing applications have also been demonstrated. Therefore, the materials have broad clinical application prospects.

Benzeneboronic-alginate/quaternized chitosan-catechol powder with rapid self-gelation, wet adhesion, biodegradation and antibacterial activity for non-compressible hemorrhage control

Although hemostatic powders have excellent adaptability for irregular and inaccessible wounds, their hemostasis for continuous bleeding or bleeding wounds of non-compressible organs remains a critical challenge. Herein, a series of benzeneboronic acid-modified sodium alginate/catechol-modified quaternized chitosan (SA-BA/QCS-C, SBQCC) powders is developed by borate ester crosslinking for non-compressible hemorrhage control. SBQCC powders possess remarkable tissue adhesion, rapid self-gelation, good cytocompatibility and antibacterial activity against S. aureus and E. coil. The blood coagulation assays show that SBQCC powders display excellent blood clotting ability due to the synergistic effect of SA-BA and QCS-C. The SBQCC2 powder with the SA-BA to QCS-C mass ratio of 5 to 3 has the greatest effect on the blood-clotting rate. Upon depositing SBQCC2 powder to bleeding wounds of rabbit liver, the powder can absorb a large amount of blood and form a stable hydrogel physical barrier at the bleeding wounds in situ to achieve non-pressing rapid hemostasis. The SBQCC2 powder also has good biocompatibility and can be degraded in vivo. Altogether, the SBQCC powders can be a promising candidate for rapid hemostasis, and these findings may provide a new perspective for improving the hemostatic efficiency of the hemostatic powder in biomedical fields.

Rapid hemostatic antibacterial self-gelling powder based on methacryloylsulfonyl betaine and quaternized carboxymethyl chitosan

Hemostatic powders can be used for deep wounds and wounds with irregular shapes that are frequently inaccessible to traditional hemostatic dressings like hemostatic gauze, sponges, and foams. In this study, sulfobetaine methacrylate (SBMA) and quaternized carboxymethyl chitosan (QCCS) were combined to create an antibacterial hemostatic hydrogel through photopolymerization under green LED irradiation, which was then changed into PSBMA/QCCS powder. PSBMA/QCCS powder could quickly form hydrogel with strong wet adhesion. The internal structure, water absorption capacity, and adhesion properties of the powder were evaluated. The coagulation ability, antimicrobial properties, and biocompatibility of the powder were also characterized. The PSBMA/QCCS powder could aggregate blood cells and platelets to enhance hemostasis. Meanwhile, PSBMA/QCCS powder also showed effective antibacterial ability against both gram-positive bacteria (Staphylococcus aureus) and gram-negative bacteria (Escherichia coli). In summary, PSBMA/QCCS powder is a promising hemostatic agent with the characteristics of quick hemostasis, tough wet adhesion, satisfactory biocompatibility, considerable antibacterial effect, and adaptability to any irregularly shaped wounds.

Sea Cucumber-Inspired Aerogel for Ultrafast Hemostasis of Open Fracture

The symptomatic management of hemorrhagic shock complicated by open fractures is a great challenge, because it is also complicated by complex wound bleeding, bacterial infection, and bone defects. Inspired by the water absorption and cross-sectional microstructure of sea cucumbers, in this study, a new sea cucumber-like aerogel (GCG) is proposed. Its aligned porous structure and composition can stop bleeding rapidly and effectively with a blood clotting index of 3.73 ± 1.8%. More importantly, the data of in vivo hemostasis test in an amputating rat tail hemostatic model (15.69 ± 2.45 s, 26.95 ± 8.43 mg) and liver puncture bleeding model (23.77 ± 2.68 s, 36.22 ± 16.92 mg) also indicate the excellent hemostatic performance of GCG. In addition, GCG also shows a significant inhibitory effect on S. aureus and E. coli, which can prevent the occurrence of postoperative osteomyelitis. Not only that, after filling in the bone defect, it is shown that this GCG aerogel completely degrades eight weeks after surgery and induces new bone ingrowth, achieving functional regeneration after hemostasis of an open fracture defect. Generally, because of its combination of hemostatic, antibacterial, and osteogenic activities, this new aerogel is a promising option for open fractures treatment.

Development potential of extracellular matrix hydrogels as hemostatic materials

The entry of subcutaneous extracellular matrix proteins into the circulation is a key step in hemostasis initiation after vascular injury. However, in cases of severe trauma, extracellular matrix proteins are unable to cover the wound, making it difficult to effectively initiate hemostasis and resulting in a series of bleeding events. Acellular-treated extracellular matrix (ECM) hydrogels are widely used in regenerative medicine and can effectively promote tissue repair due to their high mimic nature and excellent biocompatibility. ECM hydrogels contain high concentrations of extracellular matrix proteins, including collagen, fibronectin, and laminin, which can simulate subcutaneous extracellular matrix components and participate in the hemostatic process. Therefore, it has unique advantages as a hemostatic material. This paper first reviewed the preparation, composition and structure of extracellular hydrogels, as well as their mechanical properties and safety, and then analyzed the hemostatic mechanism of the hydrogels to provide a reference for the application and research, and development of ECM hydrogels in the field of hemostasis.

On the development of modular polyurethane-based bioelastomers for rapid hemostasis and wound healing

Massive hemorrhage may be detrimental to the patients, which necessitates the advent of new materials with high hemostatic efficiency and good biocompatibility. The objective of this research was to screen for the effect of the different types of bio-elastomers as hemostatic dressings. 3D loose nanofiber sponges were prepared; PU-TA/Gel showed promising potential. Polyurethane (PU) was synthesized and electrospun to afford porous sponges, which were crosslinked with glutaraldehyde (GA). FTIR and 1H-NMR evidenced the successful synthesis of PU. The prepared PU-TA/Gel sponge had the highest porosity and water absorption ratio. Besides, PU-TA/Gel sponges exhibited cytocompatibility, negligible hemolysis and the shortest clotting time. PU-TA/Gel sponge rapidly induced stable blood clots with shorter hemostasis time and less bleeding volume in a liver injury model in rats. Intriguingly, PU-TA/Gel sponges also induced good skin regeneration in a full-thickness excisional defect model as revealed by the histological analysis. These results showed that the PU-TA/Gel-based sponges may offer an alternative platform for hemostasis and wound healing.

Biomass-derived ultrafast cross-linked hydrogels with double dynamic bonds for hemostasis and wound healing

Developing novel hemostatic materials with accelerating wound healing functions has raised widespread attention recently. To adapt to irregular and incompressible wounds, we fabricated a series of biomass-derived ultrafast cross-linked adhesive hydrogels with adjustable gelation time and injectable properties through Schiff-base and ionic coordinate bonds among catechol-conjugated gelatin (GelDA), dialdehyde cellulose nanocrystals (DACNCs), calcium ions (Ca²⁺) and ferric iron (Fe³⁺). The fast-gelling hydrogels possess adjustable gelation time and mechanical properties by altering the contents of DACNCs and Fe³⁺. With double-dynamic-bond crosslinking, the hydrogels are endowed with the desired self-healing and injectable performance compared to gelatin-based hydrogels without DACNCs. Additionally, the hydrogels present enhanced adhesiveness, NIR responsiveness and antibacterial activity with the introduction of catechol groups and the formation of catechol-Fe complexes. Both in vitro and in vivo hemostatic assays and degradation experiments confirm that the hydrogels achieve rapid hemostasis and display fantastic biodegradability. As demonstrated by a rat full-thickness skin defect model, the hydrogels with multifunctionality remarkably accelerate the regeneration of wound tissues. Thus, the ultrafast cross-linked hydrogels are potentially valuable as hemostatic materials for wound healing applications in the biomedical field.

Synthesis of Carbon Dots with Hemostatic Effects Using Traditional Chinese Medicine as a Biomass Carbon Source

As novel nanomaterials developed gradually with nanotechnology, carbon dots have been widely applied in medical applications, including disease treatment, drug delivery, antibacterial applications, and phototherapy. Based on the similar process between Chinese medicinal materials for hemostasis and modern carbon dots, this paper reports the preparation of four luminescent carbon dots with Chinese medicinal materials (plants and animals) as carbon sources and the investigation on their hemostatic effects in vitro and in rat bleeding models. It is found that the four studied carbon dots exhibit similar hemostatic effects and hemostatic mechanisms through impacting both endogenous and exogenous coagulation pathways. In addition, these carbon dots all exhibit anti-inflammatory effects and good biocompatibility, ensuring their potential in pretraumatic fields. This work provides a new perspective for hemostatic carbon dots prepared using carbonized natural plants and animals and new ideas for the research of new hemostatic materials.

Intravenous Hemostats: Foundation, Targeting, and Controlled-Release

Uncontrollable blood loss is the greatest cause of mortality in prehospital patients and the main source of disability and death in hospital care. Compared with external hemostats, intravenous hemostats are more appropriate for preventing and treating uncontrolled bleeding in vivo and large bleeding on the body surface. This Review initially establishes intravenous hemostats' response basis, including the coagulation mechanism, fibrinolytic pathway, and protein corona. Second, the study of advancement of intravenous hemostat targeting was expanded from two perspectives, cellular hemostatic agents and synthetic hemostatic agents. Meanwhile, after discussing the progress of controlled-release intravenous hemostats with platelets as the stimuli, this Review offers insight into the possibility of controlled-release intravenous hemostats with microenvironment as the stimuli, combining the studies of controlled-release targeted thrombolysis.

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.

John J, Khademhosseini A. Recent advances in biopolymer-based hemostatic materials

Hemorrhage is the leading cause of trauma-related deaths, in hospital and prehospital settings. Hemostasis is a complex mechanism that involves a cascade of clotting factors and proteins that result in the formation of a strong clot. In certain surgical and emergency situations, hemostatic agents are needed to achieve faster blood coagulation to prevent the patient from experiencing a severe hemorrhagic shock. Therefore, it is critical to consider appropriate materials and designs for hemostatic agents. Many materials have been fabricated as hemostatic agents, including synthetic and naturally derived polymers. Compared to synthetic polymers, natural polymers or biopolymers, which include polysaccharides and polypeptides, have greater biocompatibility, biodegradability and processibility. Thus, in this review, we focus on biopolymer-based hemostatic agents of different forms, such as powder, particles, sponges and hydrogels. Finally, we discuss biopolymer-based hemostatic materials currently in clinical trials and offer insight into next-generation hemostats for clinical translation.

A hemostatic keratin/alginate hydrogel scaffold with methylene blue mediated antimicrobial photodynamic therapy

Uncontrollable bleeding and infection are two of the most common causes of trauma-related death. Yet, developing safe materials with high hemostatic and antibacterial effectiveness remains a challenge. Keratin-based biomaterials have been reported to exhibit the functions of enhancing platelet binding and activating and facilitating fibrinogen polymerization. In this study, we designed a hemostatic material with good biodegradability, biocompatibility, hemostatic ability, and antibacterial function to solve the shortcomings of common hemostatic materials. Methylene blue-loaded keratin/alginate composite scaffolds were prepared by the freeze-gelation method. The composite scaffolds exhibited over 1600% liquid absorption, well-interconnected pores, good biocompatibility, and biodegradability. We find that the keratin/alginate composite scaffolds' synergistic action may significantly reduce hemostasis time. To prevent infection, the drug-loaded scaffolds generated high burst release by absorbing wound exudate in the early stages of wound healing. The results obtained by the antimicrobial photoinactivation assay in vitro suggest that an antimicrobial photodynamic effect might be triggered, thereby preventing the fast growth of colonies.

Construction of multifunctional wound dressings with their application in chronic wound treatment

As the prevalence of diabetes increases year by year and the aging population continues to intensify in the world, chronic wounds such as diabetic foot ulcers and pressure ulcers have become serious problems that threaten people's health, and have brought an enormous burden to the world healthcare system. Conventional clinical treatment of chronic wounds relies on non-specific topical care (including debridement, infection/inflammation control, and frequent wound dressing changes), which can alleviate disease progression and reduce patient suffering to a certain extent, but the overall cure rate is less than 50% and the recurrence rate is high. Traditional wound dressings such as gauze, hydrocolloids, films and foams are single-function, acting as a physical barrier or absorbing exudates, and cannot meet all the needs of the entire chronic wound healing process. Recently, a large number of novel functional dressings have been reported for chronic wound repair. Based on the progress on wound dressings in recent years and the relevant research experience of our group, the review summarizes and discusses the progress on multifunctional wound dressings (such as microneedles, sponges and hydrogels) with anti-inflammatory, antioxidant, antibacterial, pro-angiogenic and tissue adhesive functions in detail. At the same time, the various responsive mechanisms (in vivo microenvironment or in vitro stimulation) of the smart multifunctional wound dressing are also analyzed in detail. It is expected that the review could provide some inspiration and suggestions for research on dressings for chronic wound treatment.

Engineered Hemostatic Biomaterials for Sealing Wounds

Hemostatic biomaterials show great promise in wound control for the treatment of uncontrolled bleeding associated with damaged tissues, traumatic wounds, and surgical incisions. A surge of interest has been directed at boosting hemostatic properties of bioactive materials via mechanisms triggering the coagulation cascade. A wide variety of biocompatible and biodegradable materials has been applied to the design of hemostatic platforms for rapid blood coagulation. Recent trends in the design of hemostatic agents emphasize chemical conjugation of charged moieties to biomacromolecules, physical incorporation of blood-coagulating agents in biomaterials systems, and superabsorbing materials in either dry (foams) or wet (hydrogel) states. In addition, tough bioadhesives are emerging for efficient and physical sealing of incisions. In this Review, we highlight the biomacromolecular design approaches adopted to develop hemostatic bioactive materials. We discuss the mechanistic pathways of hemostasis along with the current standard experimental procedures for characterization of the hemostasis efficacy. Finally, we discuss the potential for clinical translation of hemostatic technologies, future trends, and research opportunities for the development of next-generation surgical materials with hemostatic properties for wound management.

A Bio-Inorganic Hybrid Hemostatic Gauze for Effective Control of Fatal Emergency Hemorrhage in "Platinum Ten Minutes"

Death from massive hemorrhage represents a global problem. It is a challenging task to design hemostatic materials with significant efficacy, good biocompatibility, reliable safety, and high stability. In this study, we demonstrate an effective bio-inorganic hybrid hemostat fabricated by stepwise procedures of on-site growth of zeolite gauze and immobilization of trypsin on the zeolite gauze. The as-synthesized hybrid hemostat catalyzes the transition of prothrombin-to-thrombin and exhibits excellent procoagulant performance in the both normal plasma and FX-deficient plasma. The hemostatic treatment of junctional femoral artery rupture in the porcine model confirms that this hybrid hemostat manifests itself with superior hemostatic performance over commercial hemostatic dressings, in terms of a reduced time to hemostasis and blood loss. The stability of the hybrid hemostat is validated through high temperature and violent shaking evaluation. This bio-inorganic hybrid hemostat displays high procoagulant activity, low cytotoxicity, and extended shelf life which may achieve the "Platinum Ten Minutes" rescue in battlefield and traffic accident medicine.

Green hemostatic sponge-like scaffold composed of soy protein and chitin for the treatment of epistaxis

Epistaxis is one of the most common otorhinolaryngology emergencies worldwide. Although there are currently several treatments available, they present several disadvantages. This, in addition to the increasing social need of being environmentally respectful, led us to investigate whether a sponge-like scaffold (SP–CH) produced from natural by-products of the food industry — soy protein and β-chitin — can be employed as a nasal pack for the treatment of epistaxis. To evaluate the potential of our material as a nasal pack, it was compared with two of the most commonly used nasal packs in the clinic: a basic gauze and the gold standard Merocel®. Our SP-CH presented great physicochemical and mechanical properties, lost weight in aqueous medium, and could even partially degrade when incubated in blood. It was shown to be both biocompatible and hemocompatible in vitro, clearing up any doubt about its safety. It showed increased blood clotting capacity in vitro, as well as increased capacity to bind both red blood cells and platelets, compared to the standard gauze and Merocel®. Finally, a rat-tail amputation model revealed that our SP-CH could even reduce bleeding time in vivo. This work, carried out from a circular economy approach, demonstrates that a green strategy can be followed to manufacture nasal packs using valorized by-products of the food industry, with equal or even better hemostatic properties than the gold standard in the clinic.

Bioactive Materials Promote Wound Healing through Modulation of Cell Behaviors

Skin wound repair is a multistage process involving multiple cellular and molecular interactions, which modulate the cell behaviors and dynamic remodeling of extracellular matrices to maximize regeneration and repair. Consequently, abnormalities in cell functions or pathways inevitably give rise to side effects, such as dysregulated inflammation, hyperplasia of nonmigratory epithelial cells, and lack of response to growth factors, which impedes angiogenesis and fibrosis. These issues may cause delayed wound healing or even non-healing states. Current clinical therapeutic approaches are predominantly dedicated to preventing infections and alleviating topical symptoms rather than addressing the modulation of wound microenvironments to achieve targeted outcomes. Bioactive materials, relying on their chemical, physical, and biological properties or as carriers of bioactive substances, can affect wound microenvironments and promote wound healing at the molecular level. By addressing the mechanisms of wound healing from the perspective of cell behaviors, this review discusses how bioactive materials modulate the microenvironments and cell behaviors within the wounds during the stages of hemostasis, anti-inflammation, tissue regeneration and deposition, and matrix remodeling. A deeper understanding of cell behaviors during wound healing is bound to promote the development of more targeted and efficient bioactive materials for clinical applications.

Analyzing Liver Tissue Responses To Local Hemostatic Agents

Objective – Our study aimed at evaluating changes in liver tissues after simulated injury and use of novel hemostatic agents (containing tranexamic acid) in the course of in vivo experiment. Material and Methods – The following hemostatic agents were studies: TachoComb collagen plate (Group 1); samples of novel local hemostatic agents based on sodium carboxymethyl cellulose (CMC), Na-CMC (Group 2); Na-CMC + tranexamic acid (Group 3). We performed the study on 30 rabbits with simulated liver laceration via laparoscopy, and were stopping bleeding by means of the above-mentioned methods. Then, on liver tissue micrographs, we were measuring capsule thickness (μm), sizes of hepatocytes and their nuclei (px), number of binuclear hepatocytes. We were also calculating nuclear-cytoplasmic ratio (NCR) of hepatocytes, as well as identifying qualitative and quantitative capsule composition in tested samples. Results – In the collagen plate group, the capsule width was 3.2-fold and 3.6-fold of this parameter in samples from Groups 2 and 3. Indirectly, this finding implied more severe inflammatory and regenerative processes aimed at limiting injury area, and was confirmed by statistically significant differences in the cellular composition of the capsule surrounding tested samples (fibroblastic cells predominated in Groups 2 and 3, and there were fewer of them in Group 1). The highest cell index (CI) value was detected in Group 3. Conclusion – A significant boundary zone separating tested materials from the liver parenchyma was also observed due to connective tissue growth as part of inflammatory response.

Effect of naturally derived surgical hemostatic materials on the proliferation of A549 human lung adenocarcinoma cells

Hemostatic materials are generally applied in surgical operations for cancer, but their effects on the growth and recurrence of tumors are unclear. Herein, three commonly used naturally derived hemostatic materials, gelatin sponge, Surgicel (oxidized regenerated cellulose), and biopaper (mixture of sodium hyaluronate and carboxymethyl chitosan), were cocultured with A549 human lung adenocarcinoma cells in vitro. Furthermore, the performance of hemostatic materials and the tumorigenicity of the materials with A549 ​cells were observed after subcutaneous implantation into BALB/c mice. The in vitro results showed that biopaper was dissolved quickly, with the highest cell numbers at 2 and 4 days of culture. Gelatin sponges retained their structure and elicited the least cell infiltration during the 2- to 10-day culture. Surgicel partially dissolved and supported cell growth over time. The in vivo results showed that biopaper degraded rapidly and elicited an acute Th1 lymphocyte reaction at 3 days after implantation, which was decreased at 7 days after implantation. The gelatin sponge resisted degradation and evoked a hybrid M1/M2 macrophage reaction at 7–21 days after implantation, and a protumor M2d subset was confirmed. Surgicel resisted early degradation and caused obvious antitumor M2a macrophage reactions. Mice subjected to subcutaneous implantation of A549 ​cells and hemostatic materials in the gelatin sponge group had the largest tumor volumes and the shortest overall survival (OS), while the Surgicel and the biopaper group had the smallest volumes and the longest OS. Therefore, although gelatin sponges exhibited cytotoxicity to A549 ​cells in vitro, they promoted the growth of A549 ​cells in vivo, which was related to chronic M2d macrophage reaction. Surgicel and biopaper inhibited A549 ​cell growth in vivo, which is associated with chronic M2a macrophage reaction or acute Th1 lymphocyte reaction.

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The gelatin sponge, Surgicel and biopaper had different effects on A549 ​cell growth and proliferation.

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Biopaper degraded rapidly in vivo and elicited an antitumor Th1 lymphocyte reaction at acute inflammatory phase.

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The gelatin sponge resisted degradation and evoked a protumor M2d macrophage reactions.

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Surgicel resisted early degradation and caused obvious antitumor M2a macrophage reactions.

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...

Polymeric Materials for Hemostatic Wound Healing

Hemorrhage is one of the greatest threats to life on the battlefield, accounting for 50% of total deaths. Nearly 86% of combat deaths occur within the first 30 min after wounding. While external wound injuries can be treated mostly using visual inspection, abdominal or internal hemorrhages are more challenging to treat with regular hemostatic dressings because of deep wounds and points of injury that cannot be located properly. The need to treat trauma wounds from limbs, abdomen, liver, stomach, colon, spleen, arterial, venous, and/or parenchymal hemorrhage accompanied by severe bleeding requires an immediate solution that the first responders can apply to reduce rapid exsanguinations from external wounds, including in military operations. This necessitates the development of a unique, easy-to-use, FDA-approved hemostatic treatment that can deliver the agent in less than 30 s and stop bleeding within the first 1 to 2 min at the point of injury without application of manual pressure on the wounded area.

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.

Blood-clotting model and simulation analysis of polyvinyl alcohol-chitosan composite hemostatic materials

The blood-clotting performance and characteristics of hemostatic materials are critical for their development and actual application. Based on the theory of porous media and characteristics of a non-Newtonian fluid, this study proposed an adsorption factor to characterize the porosity generation and blood coagulation process of hemostatic materials. On this basis, we constructed a physical model of blood coagulation in a porous medium integrated with the power-law fluid model to study the proposed poly(vinyl alcohol)-chitosan (PVA-CS) composite hemostatic material. Moreover, we simulated the dynamic blood flow process and blood coagulation process in the PVA-CS hemostatic material by introducing the physical model. The simulation results show that the blood begins to coagulate, which affects the porosity and permeability of the blood-containing area, resulting in changing the porosity after blood flowed into the hemostatic material. The porosity, permeability, and blood flow rate will approach zero until the generated blood coagulation entirely blocked the porous medium. Besides, simulation can provide the pressure and velocity distribution varying in the coagulation process of hemostatic materials. The temperature will also influence the hemostatic performance of the PVA-CS material. In all, the proposed simulation method enabled the coagulation mechanism of PVA-CS to be revealed from the perspective of blood flow in porous media combined with the adsorption factor.

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.

Multifunctional dopamine modification of green antibacterial hemostatic sponge

A novel hemostatic nanocomposite (OBC-PDA/PDA-MMT/Ag NPs) was prepared. As Functional hemostatic particles, hydrochloric acid modified montmorillonite coated with dopamine (PDA-MMT) doped into oxidized bacterial cellulose (OBC). In the presence of carboxyl and dopamine, silver ions (Ag⁺) were reduced into Ag nanoparticles (Ag NPs) distributed homogeneously on the matrix of PDA-MMT and OBC. Then, dopamine was grafted onto the oxidized bacterial cellulose under the crosslinking effect of 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC). After dopamine was grafted onto the oxidized bacterial cellulose, the interaction between PDA-MMT and the whole material was enhanced, and the flexibility was also improved. OBC-PDA/PDA-MMT/Ag NPs hemostatic sponge have appropriate mechanical strength, broad-spectrum antibacterial properties and excellent biodegradability. The hemostatic sponge with addition of PDA-MMT and Ag NPs is expected to provide functional properties such as rapid hemostasis, bacteriostasis and wound healing. In addition, the hemostatic effect of the compound was confirmed in vivo. The hemostatic sponge showed greater coagulation capacity, higher adherent red blood cells and platelets, and lower blood loss. The results show that hemostatic sponge is a rapid and effective coagulant with good antibacterial properties.

Study on hemostatic effect and mechanism of starch-based nano-microporous particles

The powdered hemostatic particles have broad application prospects in large open wounds, internal organ injuries and penetrating injuries of the body. In this study, nanoscale mescoporous and macroporous silica (MMSN), nanoscale mescoporous and macroporous bioactive glass (MBG), micron-scale cross-linked corn starch porous microspheres (CMS), MMSN@CMS and MBG@CMS starch-based nano-microporous particles were synthesized and their hemostatic effect and hemostatic mechanism were studied. The results showed that comparted with the single particle of CMS, the combination particles MBG@CMS and MMSN@CMS significantly increased the water absorption rate, activated both internal and external coagulation pathways, significantly shortened CBT, as well as the improved hemostatic effects in vitro. The immediately released Ca²⁺ from MBG@CMS in the blood to participate in the coagulation pathway, and MMSN@CMS activated platelets by concentrating blood coagulation factors, might be the main hemostatic mechanisms for the starch-based nano-microporous particles. Furthermore, the hemostatic efficacy of particles, both in the model of tail-amputation and liver injury in SD rats, showed the starch-based nano-microporous particles, especial MBG@CMS, could significantly reduce the weight of blood loss and shorten the bleeding time. Our research work stated that the starch-based nano-microporous particles MBG@CMS might be a hemostasis biomaterial with the potential applications for the emergency bleeding.