In clinical surgery and trauma treatment, the selection of hemostatic materials directly influences therapeutic outcomes. The mainstream hemostatic materials currently available include collagen, microporous polysaccharides, gelatin, oxidized cellulose, thrombin, and their composite preparations. Each type of hemostatic material has a distinct mechanism of action, along with unique advantages, limitations, and suitable application scenarios. This article compares and analyzes these mainstream hemostatic materials in terms of their mechanisms, benefits, and drawbacks.
1. Collagen Hemostatic Materials
Mechanism:
Promotes platelet adhesion and activation to accelerate the coagulation process.
Advantages:
Minimal swelling, reducing the risk of compression on surrounding tissues.
Short absorption cycle (<8 weeks), suitable for scenarios requiring rapid degradation.
Effective in controlling large-area parenchymal bleeding (e.g., liver and spleen surgeries).
Disadvantages:
Animal-derived origin may trigger immune responses or infection risks.
High production costs limit economic feasibility.
2. Microporous Polysaccharide (Starch/Chitosan) Hemostatic Materials
Mechanism:
Utilizes a porous structure to adsorb coagulation components, accelerate the aggregation of red blood cells and platelets, and enhance endogenous coagulation.
Advantages:
Molecular sieve effect efficiently adsorbs coagulation factors and exudate.
Suitable for controlling wound bleeding (e.g., in orthopedics and burns).
Easy to use without the need for special pretreatment.
Disadvantages:
Excessive hygroscopicity may reduce local adhesion.
Limited effectiveness in controlling rapid arterial bleeding.
3. Gelatin (Sponge/Gel) Hemostatic Materials
Mechanism:
Provides a physical matrix to support blood clot formation.
Advantages:
Moderate absorption period (4–6 weeks), compatible with physiological hemostatic agents (e.g., thrombin).
Effective for small vessel bleeding (e.g., neurosurgery, dentistry).
Neutral pH ensures good tissue compatibility.
Disadvantages:
Water absorption and expansion may compress nerves or displace the sponge.
Contraindicated in vascular cavities due to embolism risks.
4. Oxidized Cellulose/Regenerated Oxidized Cellulose
Mechanism:
Promotes clot formation through a physical matrix and exhibits a mild antibacterial effect due to its weak acidity.
Advantages:
Rapid hemostasis, particularly suitable for dry-use scenarios (e.g., cardiovascular surgery).
Antimicrobial properties help reduce postoperative infection risks.
Degradable within 2–6 weeks, with low residue risk.
Disadvantages:
Weak acidity may induce local inflammatory reactions.
Incompatible with biological hemostatic agents (e.g., thrombin), limiting its application range.
5. Thrombin
Mechanism:
Directly activates fibrinogen to convert into fibrin, accelerating the coagulation cascade.
Advantages:
Rapid onset, suitable for capillary and small vein bleeding (e.g., general surgery, plastic surgery).
Flexible application methods, such as spraying or local infiltration.
Disadvantages:
Animal-derived thrombin (e.g., bovine source) may cause allergic reactions or thrombosis.
Human-derived thrombin is contraindicated for patients sensitive to human blood products.
6. Fibrinogen-Thrombin Complex
Mechanism:
High concentrations of coagulation factors directly induce fibrin cross-linking to form a stable clotting network.
Advantages:
Fastest hemostatic action, ideal for high-risk bleeding scenarios (e.g., organ transplantation, major vascular anastomosis).
Ready-to-use without premixing.
Fully absorbable with high biocompatibility.
Disadvantages:
High cost limits widespread use.
Potential risk of blood-borne infections due to incomplete virus inactivation.
Conclusion
In conclusion, the development trends of hemostatic products include the following:
Synthetic materials are expected to gradually replace animal-derived products.
Multifunctional hemostatic materials with antibacterial, anti-adhesion, and tissue-repair promoting properties will be developed.
Cost control will become increasingly important, with efforts to reduce the prices of high-end biomaterials through large-scale production.
Precise adaptation of materials based on bleeding types and anatomical sites will be emphasized.
With ongoing advancements in material science and bioengineering, future hemostatic materials are expected to be safer, more effective, and more cost-efficient, providing better solutions for surgical applications.