Local hemostatic agents and ways of their improvement

Abstract

Recently, local hemostatic agents (LHA) have become increasingly popular abroad and in our country. They act in a targeted way and can be used both in damage to large vessels and in diffuse bleeding. In the article, chemical nature, physical and chemical characteristics of materials and mechanisms of LHA activity are considered, directions of their improvement are shown. LHA are mostly classified by mechanism of action.
 To date, the popular groups of hemostatic agents are «mucoadhesive agents» (chitosan, amylopectin) and «coagulation factors concentrators» (zeolites, kaolin). Other authors distinguish the group of «aggregation and adhesion stimulants» (collagen, cellulose). Here, representatives of these groups have common characteristics – very high porosity and hydration ability. Another group includes substances that «promote protein denaturation» (inorganic salts of metals, as well as salts of acrylic acid and its derivatives). Polyacrylates are the basis of adhesives with hemostatic activity. However, most modern LHA are complex drugs and it is just this group that is most promising. All means, from hemostatic sponges produced by Zelyonaya Dubrava (Russia) and Nycomed, Takeda (Austria, Norway), and to hemostatic materials of MedTrade manufacture (Great Britain), Etiguette and Z-Medica (USA), combine sorption and, actually, thrombotic properties. The trademarks often imply original compositions and, especially, technologies: Quick Relief, BioSeal, BallistiClot, Hemaderm, CELOX Gauze PRO, OMNI-STAT Hemostatic Gauze for minor external bleeding. The most effective LHA are those based on chitosan and kaolin in the form of dressings with embedded clot-forming substance, for example, with artificial platelets or other coagulation factors.

Unusual Surface Coagulation Activation Patterns of Crystalline and Amorphous Silicate‐Based Biominerals

“…Materials' hemostatic characteristics are intimately connected to their macro-micro scopic interface patterns with blood. Through chemical activation of coagulation factors (inorganic salts), [1,10,11] blood cell action (chitosan), [12,13] physical expansion and compression (bandage), [2] adsorption and concentration (sponge), [12][13][14] the coagulation mechanisms of these hemostats are mainly described from macroscopic perspectives, which lacks theoretical direction for the development of novel materials and occasionally overlooks the possible adverse consequences of materials. This research demonstrates the impact of the hydration layer, electronegativity, protein-specific binding, and microenvironment on the whole plasma coagulation process, as well as a full investigation of comprehensive hemostasis and its possible negative consequences.…”

“…[7] Clarifying the structure-activity link between materials and thrombin activation is crucial for developing innovative therapeutic strategies to promote fast hemostasis and increase the survival rate of patients with major bleeding. [8,9] Presently, mineral salt-impregnated gauze, [1,10,11] chitosanbased hemostatic powder, gauze, and sponge, [12,13] polyurethane foam, [2,14] expandable compression sponge, [2] sealant, [15] etc. are the most commonly used hemostatic materials for the control of massive hemorrhage in a prehospital emergency.…”

“…Presently, mineral salt‐impregnated gauze, [ 1,10,11 ] chitosan‐based hemostatic powder, gauze, and sponge, [ 12,13 ] polyurethane foam, [ 2,14 ] expandable compression sponge, [ 2 ] sealant, [ 15 ] etc. are the most commonly used hemostatic materials for the control of massive hemorrhage in a prehospital emergency.…”

Local hemostatic biomaterial based on native collagen

“…Hemostatic sponges are more effectively introduced into clinical practice as a means of local action. Biomaterials based on collagen cause active adhesion and aggregation of platelets [1]. The hygroscopicity and high sorbing ability of collagen make its preparations indispensable in wound dressings.…”