Hemostatic Agents in Surgical Applications

Effective control of bleeding is a cornerstone of modern surgery, encompassing both routine procedures and major trauma interventions. Haemostatic agents serve as adjuncts when conventional methods such as direct pressure, suturing or cautery prove insufficient. Broadly, these agents fall into mechanical, active and sealant categories. Mechanical products—comprising collagen sponges, oxidized cellulose or gelatin meshes—provide a scaffold for clot formation. Active agents incorporate biological factors, notably fibrinogen and thrombin, to catalyse the final steps of the coagulation cascade. Sealants, often based on synthetic polymers or peptides, adhere to tissue surfaces and promote rapid barrier formation. Recent generations of materials combine multiple mechanisms to achieve both rapid haemostasis and favourable tissue compatibility, while minimising inflammation and foreign-body reactions. Developments in polymer chemistry, bio-inspired adhesives and self-assembling systems are broadening the arsenal available to surgeons, with applications ranging from parenchymal organ resections to vascular and cardiothoracic procedures. As healthcare systems strive to reduce transfusion rates and associated costs, the global significance of optimised haemostats continues to drive both fundamental research and clinical innovation.

Research from Nature Portfolio

A foundational study has examined the cellular impact of oxidized cellulose hemostats on human stromal fibroblasts. Both regenerated and non-regenerated oxidized cellulose were shown to inhibit fibroblast proliferation, migration and extracellular matrix contraction in vitro, with non-regenerated forms exerting stronger inhibition. These findings reveal that the microstructure and chemical properties of cellulose hemostats not only influence immediate clotting but also modulate key wound-healing processes. Such insights underscore the need to balance rapid bleeding control with preservation of normal tissue repair in surgical practice.

Hemostatic Agents in Surgical Applications publication trend

The graph below shows the total number of articles in hemostatic agents in surgical applications across all publications each year (not limited to Nature Index journals).

Technical terms

Active haemostat: contains biological clotting factors such as fibrinogen and thrombin to accelerate clot formation at the bleeding site.

Mechanical haemostat: provides a physical barrier to bleeding, typically composed of absorbable materials such as collagen or cellulose fibres.

Sealant: a fluid or paste-like agent that adheres to tissue surfaces to form a physical barrier and promote coagulation.

Oxidized regenerated cellulose (ORC): a plant-derived absorbable matrix that lowers pH to aid in coagulation and exhibits bactericidal properties.

Polyoxazoline: a synthetic polymer used in advanced haemostatic patches to enhance adhesion and rapid clot formation.

References

1. Efficacy of a novel polyoxazoline-based hemostatic patch in liver and spleen surgery. World Journal of Emergency Surgery (2023).
2. Advances in the development of hemostatic biomaterials for medical application. Biomaterials Research (2021).
3. Oxidized (non)-regenerated cellulose affects fundamental cellular processes of wound healing. Scientific Reports (2016).