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.