Bleeding complications arising from trauma, surgery, as well as congenital, disease-associated or drug-induced blood disorders can cause significant morbidities and mortalities in civilian and military populations. Therefore, stoppage of bleeding (hemostasis) is of paramount clinical significance in prophylactic, surgical and emergency scenarios. For externally accessible injuries, a variety of natural and synthetic biomaterials have undergone robust research, leading to hemostatic technologies including glues, bandages, tamponades, tourniquets, dressings and procoagulant powders. In contrast, treatment of internal non-compressible hemorrhage still heavily depends on transfusion of whole blood or blood's hemostatic components (platelets, fibrinogen and coagulation factors). Transfusion of platelets poses significant challenges of limited availability, high cost, contamination risks, short shelf-life, low portability, performance variability and immunological side-effects, while use of fibrinogen or coagulation factors provides only partial mechanisms for hemostasis. With such considerations, significant interdisciplinary research endeavors have been focused on developing materials and technologies that can be manufactured conveniently, sterilized to minimize contamination and enhance shelf-life, and administered intravenously to mimic, leverage and amplify physiological hemostatic mechanisms. Here we provide a comprehensive review regarding the various topical, intra-cavitary and intravenous hemostatic technologies in terms of materials, mechanisms and state-of-art, and discuss challenges and opportunities to help advancement of the field.
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