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Review
. 2014 Nov;102(11):4182-94.
doi: 10.1002/jbm.a.35052. Epub 2013 Dec 12.

Hemostatic strategies for traumatic and surgical bleeding

Adam M Behrens  1 , Michael J Sikorski, Peter Kofinas
Affiliations
Review

Hemostatic strategies for traumatic and surgical bleeding

Adam M Behrens et al. J Biomed Mater Res A. 2014 Nov.

Abstract

Wide interest in new hemostatic approaches has stemmed from unmet needs in the hospital and on the battlefield. Many current commercial hemostatic agents fail to fulfill the design requirements of safety, efficacy, cost, and storage. Academic focus has led to the improvement of existing strategies as well as new developments. This review will identify and discuss the three major classes of hemostatic approaches: biologically derived materials, synthetically derived materials, and intravenously administered hemostatic agents. The general class is first discussed, then specific approaches discussed in detail, including the hemostatic mechanisms and the advancement of the method. As hemostatic strategies evolve and synthetic-biologic interactions are more fully understood, current clinical methodologies will be replaced.

Keywords: hemorrhage; hemostasis; hemostatic; surgery; trauma.

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Figures

FIGURE 1
FIGURE 1
Schematic of the coagulation cascade. Activation of the contact activation and/or the tissue factor pathway causes successive proteolytic steps that result in the formation of a crosslinked fibrin clot. Each coagulation factor is represented with a Roman numeral and active form with the letter a.
FIGURE 2
FIGURE 2
Structures of naturally derived polysaccharides: (a) chitosan, (b) cellulose, and (c) dextran.
FIGURE 3
FIGURE 3
Structure of (a) chitosan, (b) PEG-tyramine functionalized chitosan, (c) catechol-conjugated chitosan, and (d) hydrophobically modified chitosan.
FIGURE 4
FIGURE 4
Schematic of the Schiff-base reaction utilized for gel formation or tissue adhesion.
FIGURE 5
FIGURE 5
Schematic of catechol reactions with thiol and amine containing compounds.
FIGURE 6
FIGURE 6
Schematic of platelet substitute hemostatic mechanism in a vascular injury. Platelet substitutes passively circulate until reaching an injury target.
See this image and copyright information in PMC

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