Hemostatic Research Articles

Bloodless Cardiac Surgery in Jehovah's Witness: A Comprehensive Review.

This article explores the major challenges and specialized strategies involved in managing cardiovascular surgery patients who are Jehovah's Witnesses and refuse blood transfusions due to their religious beliefs. It delves into preoperative, intraoperative, and postoperative approaches aimed at minimizing blood loss and optimizing patient outcomes while respecting their autonomy. Preoperative measures focus on correcting anemia and coagulopathy through targeted interventions, such as iron supplementation and erythropoietin therapy, and meticulous screening for bleeding disorders. Intraoperative techniques include the use of vasoconstrictors, hemostatic agents, and innovative blood conservation methods like acute normovolemic hemodilution and cell salvage. Postoperative care emphasizes infection control, hemostasis, and judicious monitoring to prevent anemia and facilitate recovery. Through a multidisciplinary approach and adherence to evidence-based practices, healthcare providers can effectively meet the needs of Jehovah's Witness patients, ensuring safe and successful cardiovascular surgery outcomes without the use of blood transfusions.

Nature-Inspired Gelatin-Based Adhesive Hydrogel: A Rapid and User-Friendly Solution for Hemostatic Applications.

Conventional hemostatic agents face challenges in achieving rapid hemostasis and effective tissue repair due to limited hemostatic scenarios, suboptimal efficacy, and inadequate adhesion to wet tissues. Drawing inspiration from nature-sourced materials, a gelatin-based adhesive hydrogel (AOT) is designed, easily prepared and quick to form, driven by Schiff base and multiple hydrogen bonds for applications in arterial and liver bleeding models. AOT exhibits exceptional adhesion to wet tissues (48.67±0.16kPa) and displays superior hemostatic properties with reduced blood loss and hemostatic time compared to other hydrogels and conventional hemostatic materials. Moreover, AOT exhibits good biocompatibility and biodegradability. In summary, this easily prepared adhesive hydrogel has the potential to supplant traditional hemostatic agents, offering a novel approach to achieve swift sealing of hemostasis and facilitate wound healing and repair in broader application scenarios, owing to its unique advantages.

Iron(III) Monoglycerolate: A Potential Hemostatic Agent for Topical Application

Background: Glycerolates of biogenic elements are of interest because of their pharmacological activity. Some of them are used as active substances in agents for topical application and as biocompatible precursors in sol-gel synthesis of bioactive materials. Objective: In this work, morphostructural feature, ability to hydrolyze, and the pharmacological activity of previously synthesized iron(III) monoglycerate were studied. Methods: Analytical techniques, including SEM, TEM, XRD, TGA, IR spectroscopy, DLS and ELS, were used. Hemostatic activity was studied in vivo, and primary toxicological studies were carried out on experimental animals. Antimicrobial activity was studied using the agar diffusion method. Results: When dispersed in glycerol, solid crystalline iron(III) monoglycerolate transforms into an amorphous state, forming aggregates with an average particle size of 250 nm (according to DLS data). It slowly hydrolyzes in water at room temperature, while hydrolysis does not take place in an aqueous glycerol media. Iron(III) monoglycerolate is nontoxic and exhibits pronounced hemostatic activity and low antibacterial activity (relative to the strain S. аureus). Conclusion: Iron(III) monoglycerolate can be considered a potential hemostatic agent, showing promise for topical application in medical and veterinary practice, as well as a novel biocompatible precursor in the sol-gel synthesis of practically useful substances.

Clotting Blood into an Adhesive Gel by Hemostatic Powder Based on Cationic/Anionic Polysaccharides and Laponite.

Hemostatic powder is widely employed for emergency bleeding control due to its ability to conform to irregularly shaped wounds, ease of use, and stable storage. However, current powders exhibit limited tissue adhesion and insufficient support for thrombus formation, making them easily washed away by blood. In this study, a hybrid powder (QAL) was produced by mixing quaternized chitosan (QCS) powder, catechol-modified alginate (Cat-SA) powder, and laponite (Lap) powder. Upon addition of QAL, the blood quickly transformed to a robust and adhesive blood gel. The adhesion strength of the blood gel was up to 31.33 ± 1.56 kPa. When compared with Celox, QAL showed superior performance in promoting hemostasis. Additionally, QAL exhibited effectiveness in eliminating bacteria while also demonstrating outstanding biocompatibility with cells and blood. These favorable properties, including strong coagulation, adhesion to wet tissue, antibacterial activity, biosafety, ease of use, and stable storage, make QAL a promising emergency hemostatic agent.

Evaluating the safety and efficacy of a novel polysaccharide hemostatic system during surgery: A multicenter multispecialty prospective randomized controlled trial

BackgroundOperative blood loss is associated with postoperative morbidity and mortality in surgery. Hemostatic agents are used as adjuncts for hemostasis during surgery and help to prevent postoperative bleeding. We evaluated the safety and efficacy of an investigational polysaccharide hemostatic (PH) topical product compared to a U.S. Food and Drug Administration (FDA)-approved control in clinical use comprising microporous polysaccharide hemospheres (MPH) to achieve hemostasis of bleeding surfaces during surgery. Study designThis prospective multicenter trial enrolled patients undergoing open elective cardiac, general, or urologic surgery. Patients were stratified by bleeding severity and therapeutic area, then randomized 1:1 to receive PH or MPH. Bleeding assessments occurred intraoperatively using a novel bleeding assessment methodology. Primary endpoint was noninferiority as compared with control via effective hemostasis at 7 min. Patients were monitored and followed daily in the postoperative period until time of discharge and again at 6 weeks. Overall survival was assessed in oncology patients at 24 months. Safety of PH vs. MPH was determined by comparing relative incidence of adverse events. ResultsAcross 19 centers, 324 (161 PH, 163 MPH) patients were randomized (48 % general surgery, 27 % cardiac surgery, and 25 % urologic surgery). PH was noninferior to MPH and met the primary endpoint of hemostatic success at 7 min at a non-inferiority margin of 10 %. No significant differences were found in adverse event rates. Six deaths were reported within the 6-week follow-up period. No difference in overall survival was observed at 2 years (76 % PH vs. 74 % MPH, P = .66) for patients undergoing cancer operations. ConclusionAcross three therapeutic areas, PH was noninferior to MPH at all hemostasis assessment time points with no safety concerns. PH is an effective alternative to MPH for hemostasis during surgery.ClinicalTrials.gov Identifier: NCT02359994

Assessment of a randomized controlled trial on the safety of pre-placing bronchial balloons in transbronchial lung cryobiopsy for diagnosing interstitial lung disease

Rationale and objectivesBleeding is a major complication of transbronchial lung cryobiopsy (TBLC), and pre-placing a bronchial balloon is one of the clinical practices used to prevent it, but with very weak evidence, which should be confirmed. This study aimed to conduct whether pre-placing a bronchial balloon in TBLC for diagnosing interstitial lung disease (ILD) is more safety.Materials and methodsIn this prospective, single-center, randomized controlled trial, patients with suspected ILD were enrolled and randomly assigned to pre-placed balloon and none-pre-placed balloon groups. The primary outcome was incidence of moderate bleeding in each group. The secondary endpoints were the incidence of severe bleeding, pneumothorax, and other procedural complications.ResultsExactly 250 patients were enrolled between August 2019 and March 2022, with 125 in each group. There were no significant differences in severe bleeding between the none-pre-placed balloon group and pre-placed balloon group (1.6% vs. 0.8%; adjusted p = 0.520), while more moderate bleeding occurred in the none-pre-placed balloon group (26.4% vs. 6.4%, adjusted p = 0.001), as well as more use of hemostatic drug (28.0% vs. 6.4%, adjusted p = 0.001). Three patients in the none-pre-placed balloon group used the bronchial balloon. More samples could be acquired in the pre-placed balloon group than in the none-pre-placed balloon group (3.8 ± 0.9 vs. 3.1 ± 0.9, p < 0.001). There were no significant differences in multidisciplinary discussion (MDD) between the two groups (89.6% vs. 91.2%, adjusted p = 0.182).ConclusionA pre-placed bronchial balloon can reduce the incidence of moderate bleeding and increase the confidence of the bronchoscopists. However, it had no effect on increasing the diagnostic rate of MDD and reducing severe bleeding.Registration number: NCT04047667 (www.clinicaltrials.gov identifier).

Design and Development of a Cost-Effective Transnasal Skull Base Bone Wax Applicator: A Technical Note.

Bone wax is an important hemostatic agent used in neurosurgical practice from more than a century. It acts by mechanical tamponade effect to stop the oozing from cancellous bone. Bone wax application over the skull surface over the vertex is easy and can be applied with fingers. In deeper areas, one uses dissector to apply the bone wax; however, it becomes difficult at times to apply in transnasal surgery using the same dissectors. Author designed a cost-effective 20-cm-long different angled bone wax applicator for skull base transnasal surgery. This applicator is cost-effective and not described previously in English literature.

Effectiveness and economic outcomes in patients undergoing laparoscopic radical prostatectomy with a new surgical shear with an integrated energy system: A retrospective study based on a tertiary hospital database in China

ObjectiveThis study aimed to demonstrate a new surgical shear with an integrated energy system (Harmonic ACE®+7) value by determining its effectiveness and economic outcomes compared with conventional ultrasonic shears (CUSs) in a real-world setting. MethodsThis was a retrospective study of adults with prostate cancer undergoing laparoscopic radical prostatectomy with the ACE®+7 shear or CUSs between August 2019 and April 2021 at Shanghai Ruijin Hospital (the headquarters and Luwan Center in China). Demographic and diagnosis information, intraoperative and postoperative clinical outcomes, and total and categorical costs were collected. Propensity score matching was performed to form the study population for each clinical group. Data were compared between the two groups using t-test and Chi-squared test. ResultsThe ACE®+7 was associated with a lower mean number of hemostatic clips used per surgery compared with CUSs (12.8 vs. 19.8, p<0.001), a moderate but not significant difference in mean postoperative drainage duration (6.6 [standard deviation, SD 2.2] days vs. 7.9 [SD 4.1] days, p=0.082), a reduction on mean total drainage volume (275.5 [SD 374.3 mL vs. 492.9 [SD 1495.0] mL, p=0.321), and a lower average rate of postoperative hemostatic drug usage (16.0% vs. 52.0%, p<0.001). There was no significant difference in total costs between the ACE®+7 and CUS groups. ConclusionThis study provides real-world data demonstrating that the ACE®+7 shear with an integrated energy system improves clinical outcomes compared with CUSs and can offer cost savings for hospitals and health systems. Using the ACE®+7 during laparoscopic radical prostatectomy allows physicians to help their patients achieve better outcomes and not spend additional money.

Superior hemostatic and wound-healing properties of tetrastigma polysaccharide

Hemostatic materials that allow fast and convenient hemostasis are urgently needed. However, obtaining an ideal hemostatic agent that exhibits biocompatibility, biodegradability, and hemostatic efficacy remains challenging. Recent studies demonstrate that morphological characteristics of hemostatic materials impact their efficacy. This study reports on the importance of morphological modification of traditional Chinese medicine plant polysaccharides. The hemostatic properties of Three-leaf Qing polysaccharides, optimized in particle (SYQ-P) and sponge (SYQ-S) forms, were investigated in vitro and in vivo. SYQ-S and SYQ-P exhibit excellent biodegradability and biocompatibility, thereby improving fibroblast cell proliferation. The hemostatic mechanism involves stable blood clot formation through intrinsic coagulation pathways. In a lethal mouse liver defect bleeding model, blood loss and clotting time were lower with polysaccharides use than with commercial hemostatic drugs. SYQ-S demonstrates instant water-triggered expansion and high absorption capacity, while the sponge-like morphological characteristics effectively improve blood component concentrations. With efficient hemostasis and excellent biocompatibility, SYQ-S dramatically accelerated wound healing in a full-thickness skin defect model in vivo. Thus, SYQ-S effectively promotes the formation of granulation tissue, collagen deposition, and angiogenesis, which ultimately accelerates wound healing. Our work highlights the design of natural Chinese medicine polysaccharides and presents a promising hemostatic agent for widespread clinical application.

The effect of a combination of kepok banana peel (musa acuminata balbisiana colla) and bay leaf (syzygium polyanthum) extracts on bleeding time in wistar rats (rattus norvegicus)

Background: The body injured potential for bleeding. Hemostatic drugs used to stop bleeding have many side effects. Kepok banana peels and bay leaves contain flavonoids and tannins which can stop bleeding.Objective: This study aims to determine the effect of a combination of kepok banana peel extract and bay leaves on bleeding time in Wistar rats. Methods: True experimental research type with post test only with control group design. 20 rats were divided into 5 groups, group K- was given aquadest, group K+ : epinephrine 1mg/1ml, group F1: kepok banana peel extract and bay leaves 25%:75%, group F2 was given extract 50:50%, and group F3 was given 75%:25% extract. Results: One Way ANOVA test obtained a value of p=0,002 showing that there was a significant difference in the time to stop bleeding for each treatment group, followed by the Post Hoc Games Howell test.Conclusion: The F3 group with a combination of 75% kepok banana peel extract and 25% bay leaf extract was the most effective group in accelerating bleeding time in Wistar rats

Strategies to Perform Emergency Laparoscopic Partial Liver Resection for Ruptured Hepatocellular Carcinoma.

Laparoscopic hepatic resection is currently used for ruptured hepatocellular carcinoma (HCC); however, it is technically challenging. We developed and implemented surgical strategies for emergency laparoscopic partial liver resection in selected patients with peripheral lesions who were hemodynamically stable and without severe liver dysfunction. The surgical techniques used were as follows. First, the Pringle maneuver was performed to control hepatic blood inflow (step 1). Next, strong hemostatic agents were applied at the rupture point of the tumor (step 2). The hanging tape was positioned along the dorsal side of the resection line to control the partial blood inflow and outflow of the tumor, as well as to expose the surgical plane (step 3). The liver parenchyma was dissected along the hanging tape (step 4). We performed emergency laparoscopic partial liver resection in three patients who were in a pre-shock status. The tumors were located in segments 6 (cases 1 and 2) and 2 (case 3). The tumor diameters were 90, 62, and 80 mm. The Preoperative Child-Pugh scores were B7, B9, and B8. The hemostatic products performed well and controlled bleeding from the ruptured HCC. The hanging tape facilitated the dissection of the liver parenchyma. The operative time and intraoperative blood loss were 135 min and 400 ml, 266 min and 200 ml, and 191 min and 495 ml for cases 1, 2, and 3 respectively. There were no in-hospital deaths. Emergency laparoscopic partial liver resection could be an option for patients with ruptured HCC.

A small-molecule hemostatic agent for the reversal of direct oral anticoagulant–induced bleeding

BackgroundThe bleeding risk associated with direct oral anticoagulants (DOACs) remains a major concern, and rapid reversal of anticoagulant activity may be required. Although specific and nonspecific hemostatic biotherapies are available, there is a need for small-molecule DOAC reversal agents that are simple and cost-effective to produce, store, and administer. ObjectivesTo identify and characterize a small molecule with procoagulant activity as a DOAC reversal agent. MethodsWe sought to identify a small procoagulant molecule by screening a chemical library with a plasma clotting assay. The selected molecule was assessed for its procoagulant properties and its ability to reverse the effects of the DOACs in a thrombin generation assay. Its activity as a DOAC reversal agent was also evaluated in a tail-clip bleeding assay in mice. ResultsThe hemostatic molecule (HeMo) dose-dependently promoted thrombin generation in plasma, with dose values effective in producing half-maximum response ranging between 3 and 5 μM, depending on the thrombin generation assay parameter considered. HeMo also restored impaired thrombin generation in DOAC-spiked plasma and reversed DOAC activity in the mouse bleeding model. HeMo significantly reduced apixaban-induced bleeding from 709 to 65 μL (vs 43 μL in controls; P < .01) and dabigatran-induced bleeding from 989 to 155 μL (vs 126 μL in controls; P < .01). ConclusionHeMo is a small-molecule procoagulant that can counterbalance hemostatic disruption by a thrombin inhibitor (dabigatran) or factor Xa inhibitors (apixaban and rivaroxaban). The compound’s effective clot formation and versatility make it a possible option for managing the inherent hemorrhagic risk during DOAC therapy.

Potential novel role of the human amniotic membrane as a sustainable hemostat.

Acute hemorrhage can cause significant morbidity and mortality arising from trauma, bleeding disorders, surgical procedures, or obstetric complications. Surgical hemostasis methods may fail to stop acute bleeding due to the complex bleeding dynamics of each bleeding type. Therefore, developing safe and effective topical hemostatic agents remains crucial. The human amniotic membrane (hAM) has established clinical evidence of effectiveness in promoting wound healing and tissue regeneration. Despite its unique biological and immunologic properties and its structural composition of established hemostatic elements, the hemostatic role of hAM has not been yet explored. The present study aimed to investigate this potential role and to describe the development protocol and characterization of hAM-derived topical hemostat. Surface electron microscope (SEM) imaging and Fourier transform infrared (FTIR) spectroscopy were used for characterization, and mouse models with induced peritoneal and tail wound bleeding were employed to evaluate the hemostatic effectiveness using physiological studies, in comparison to a chitosan-based combat-scale hemostat. The hAM hemostat showed a distinctive composition by SEM and FTIR. Applying equal masses of the hAM hemostat, the commercial hemostat, or a combination reduced peritoneal wound bleeding time to averages of 108.4, 86.2, and 76.8 s, respectively, compared to the control group (300 s). Tail wound bleeding times were similarly reduced with no significant difference between the hAM and the commercial hemostat (P values = 0.29, 0.34 in peritoneal and tail wounds, respectively). Neither hemostat affected coagulation time. This study describes a simple cost-effective preparation protocol for a hAM-based hemostatic agent. The long-recognized safety, sustainability, and immunotolerance advantages of hAM can establish superiority over commercial hemostats with reported safety concerns. Robust research validation in larger-scale bleeding models is required for wider applications and severe bleeding types.

Preparation and properties of chitosan/gelatin film containing capsaicinoid for hemostasis and antibacterial

Blood loss resulting from accidents or surgery is a worrying health problem. This is because hemorrhage can occur and cause death. Therefore, the development of safe and effective hemostatic materials is important. Hemostatic agents (Ha) made from the composite of chitosan, gelatin, and glycerol mixtures and capsaicinoids (Cap) at various compositions 0, 1, 2, 4, 6 and 12 wt%. The films forming were prepared by casting with the aim of obtaining an environmentally friendly material for intraoperative hemostasis. The characterizations of the samples were performed by physicochemical, morphological, hemostasis test, functional groups, antibacterial, and mechanical properties were evaluated. The samples received are flexible and transparent. It was found that 6 wt% Cap showed the optimization in stopping bleeding, and Cap content of 12 wt% was optimized for antibacterial properties both Staphylococcusaureus and Escherichia coli. The results show that the addition Cap into chitosan/gelatin film based Ha has high potential as a hemostatic product, and there is a very interesting trend in the development of hemostatic and antibacterial materials in the future.

Enhanced coagulation cascade activation and styptic effects of Zn@SiO2 nanocomposite

Humans often have bleeding, which exerts substantial selective pressure on the coagulation system to optimize hemostasis in a variety of situations. Uncontrolled hemorrhage due to severe trauma leads to morbidity and mortality. Although nonbiological surfaces such as silicates can activate coagulation factor XII (FXII), the presence of Zn (Zinc) in the material stimulates and activates the various steps in the coagulation cascade. This results in blood clotting. The Zn@SiO2 nanocomposite has an excellent hemostatic property that establishes hemostasis by activating the factors responsible for the formation of a stable clot called fibrin mesh. This can be used as a hemostatic agent during surgeries and in any other trauma condition related to bleeding. Zn@SiO2 was synthesized and characterized with XRD, FTIR and HRTEM. It is analyzed for its RBC (Red Blood Corpuscles) aggregation and Platelet adhesion ability, fibrin formation, thrombus formation and prothrombin time (PT), Activated Partial Thromboplastin Time (aPTT), D-dimer for its ability to activate the coagulation cascade to achieve stable clotting.

Exploring the potential of Beta Vulgaris L. Against thrombocytopenia: in vitro, in silico, phytochemicals, and antioxidant analysis

The purpose of this study was to assess anti- thrombocytopenia of beetroot extract using both in vitro and in silico methods. Additionally, antioxidant capacity, phenolic content, and flavonoid content of beetroot were determined. The extraction procedure was optimized by reflux method, the extracts obtained were examined to determine the Total Phenolic Content (TPC) and Total Flavonoid Content (TFC) using the Folin-Ciocalteu colorimetric and aluminum chloride methods, respectively. Furthermore, antioxidant capacity was assessed using the DPPH method, while betanin concentration was determined by thin-layer chromatography. This research approach encompasses the binding acticity of ligands and target proteins, the process of docking thrombopoietin receptor (TPOr) and betanin compound using Swissdock, and the examination of docking data using the USCF Chimera software. The studies revealed that the reflux-extracted beetroot extract had a total phenol concentration of 39.72 ± 2.56 mgGAE/g. The flavonoid concentration of beetroot extract obtained using reflux extraction was 5.47 ± 0.39 mg QE/g. The qualitative test conducted using thin layer chromatography yielded data indicating that the reflux-extracted extract tested positive for betanin. The reflux approach yielded an extract with antioxidant activity (IC50) of 95.71 μg/ml. The results of the molecular docking simulation showed that the betanin compound had a ΔG value of -8.1 Kcal/mol. It interacts with multiple amino acid residues, including LEU62, PRO63, ALA64, VAL65, ASP66, ARG138, THR139, THR140, ALA141, HIS142, ALA147, ILE148, LEU150, SER151, HIS154, PRO70, ARG71, ARG102, PHE104, PHE105, PRO106, and PHE126. An in vitro study demonstrated that the extract of Beta vulgaris L. has the ability to induce blood coagulation, indicating its potential as a haemostatic agent. Additionally, in silico investigations suggest that the betanin chemicals found in beetroot serve as TpoR agonists, and it can be concluded that betanin has antithrombocytopenia potential.

Self-restoring cryogels used for the repair of hemorrhagic bone defects by modulating blood clots

Bleeding from severe traumatic bone defects poses a significant threat to patient survival, and conventional hemostatic agents prove inadequate for addressing bone defects when pressure application is not feasible. Therefore, the development of a bio-multifunctional material with outstanding hemostatic and osteogenic performances is highly desirable. In this study, chitosan/hydroxyapatite nanowires cryogels (CSHAn) were fabricated via schiff base reaction and electrostatic interaction. These CSHAn cryogels demonstrate an impressive absorption capacity, reaching up to 5387 %, and possess considerable mechanical strength, quantified at 167.92 kPa, along with significant compressive recovery capabilities. CSHAn cryogels demonstrate superior blood-clotting ability, enhanced blood cell and platelet adhesion, and activation compared to gelatin sponges. Moreover, in vitro cellular assessments indicate that the developed CSHAn2 exhibits favorable cytocompatibility and significantly promote osteogenesis by upregulating the formation of alkaline phosphatase and calcium nodules. Taken together, this multi-functional cryogels is potentially valuable for clinical applications towards hemorrhagic bone defect repair.

Coagulation Tests and Reversal Agents in Patients Treated with Oral Anticoagulants: The Challenging Scenarios of Life-Threatening Bleeding and Unplanned Invasive Procedures.

In clinical practice, the number of patients treated with direct oral anticoagulants (DOACs) has consistently increased over the years. Since anticoagulant therapy has been associated with an annual incidence of major bleeding (MB) events of approximately 2% to 3.5%, it is of paramount importance to understand how to manage anticoagulated patients with major or life-threatening bleeding. A considerable number of these patients' conditions necessitate hospitalization, and the administration of reversal agents may be imperative to manage and control bleeding episodes effectively. Importantly, effective strategies for reversing the anticoagulant effects of DOACs have been well recognized. Specifically, idarucizumab has obtained regulatory approval for the reversal of dabigatran, and andexanet alfa has recently been approved for reversing the effects of apixaban or rivaroxaban in patients experiencing life-threatening or uncontrolled bleeding events. Moreover, continuous endeavors are being made to develop supplementary reversal agents. In emergency scenarios where specific reversal agents might not be accessible, non-specific hemostatic agents such as prothrombin complex concentrate can be utilized to neutralize the anticoagulant effects of DOACs. However, it is paramount to emphasize that specific reversal agents, characterized by their efficacy and safety, should be the preferred choice when suitable. Moreover, it is worth noting that adherence to the guidelines for the reversal agents is poor, and there is a notable gap between international recommendations and actual clinical practices in this regard. This narrative review aims to provide physicians with a practical approach to managing specific reversal agents.

Swift Covalent Gelation Coupled with Robust Wet Adhesive Powder: A Novel Approach for Acute Massive Hemorrhage Control in Dynamic and High-Pressure Wound Environments.

The quest for efficient hemostatic agents in emergency medicine is critical, particularly for managing massive hemorrhages in dynamic and high-pressure wound environments. Traditional self-gelling powders, while beneficial due to their ease of application and rapid action, fall short in such challenging conditions. To bridge this gap, the research introduces a novel self-gelling powder that combines ultrafast covalent gelation and robust wet adhesion, presenting a significant advancement in acute hemorrhage control. This ternary system comprises ε-polylysine (ε-PLL) and 4-arm polyethylene glycol succinyl succinate (4-arm-PEG-NHS) forming the hydrogel framework. Na2HPO4 functions as the "H+ sucker" to expedite the amidation reaction, slashing gelation time to under 10 s, crucial for immediate blood loss restriction. Moreover, PEG chains' hydrophilicity facilitates efficient absorption of interfacial blood, increasing the generated hydrogel's cross-linking density and strengthens its tissue bonding, thereby resulting in excellent mechanical and wet adhesion properties. In vitro experiments reveal the optimized formulation's exceptional tissue compliance, procoagulant activity, biocompatibility and antibacterial efficacy. In porcine models of heart injuries and arterial punctures, it outperforms commercial hemostatic agent Celox, confirming its rapid and effective hemostasis. Conclusively, this study presents a transformative approach to hemostasis, offering a reliable and potent solution for the emergency management of massive hemorrhage.

Absorbable Hemostatic Agents Mimic Gossypiboma or Infected Collection on Imaging

AbstractAbsorbable hemostatic agents are commonly used in clinical practice and their imaging appearance is less known. In our case series, we demonstrate how absorbable hemostatic agents can masquerade as other clinically and medicolegally significant conditions such as gossypiboma and infected collections. Through our report, we aimed to describe the imaging features of absorbable hemostatic agents, to compare them with their imaging mimics, and provide a comprehensive review of the available literature.