Topical Haemostatic Agents In Modern Surgery: A Mechanism-Oriented Classification

Öz

Haemostasis is a complex physiological process involving vascular responses, platelet activation and coagulation cascade interactions that collectively maintain vascular integrity following tissue injury. Despite substantial advances in surgical techniques and perioperative care, intraoperative and postoperative bleeding remain major challenges in modern surgery. Consequently, topical haemostatic agents have evolved from simple passive materials to advanced biologically active, flowable, sealant-based and regenerative platform. This review provides a mechanism-oriented overview of topical haemostatic agents and their clinical applications through a structured classification framework integrated with the physiological basis of coagulation. A narrative review of currently available topical haemostatic agents was performed, classifying agents into five major categories according to material composition, mechanism of action and functional characteristics: mechanical scaffold haemostatic agents, biologically active haemostatic agents, flowable haemostatic agents, sealant and adhesive haemostatic agents and emerging regenerative haemostatic technologies. Mechanical scaffold agents remain foundational tools for routine bleeding control, whereas biologically active and flowable haemostats offer enhanced efficacy in complex bleeding environments. Sealant and adhesive haemostats extend functionality beyond haemostasis towards tissue reinforcement and leakage prevention. Emerging regenerative technologies represent a developing frontier that may integrate bleeding control with tissue repair.

Anahtar Kelimeler

• Topical haemostatic agents
• Haemostasis
• Surgical bleeding
• Coagulation cascad
• Surgical sealants

Destekleyen Kurum

Preparation for publication of this article is partly supported by Turkish Neurosurgical Society

Modern Cerrahide Topikal Hemostatik Ajanlar: Mekanizma Odaklı Bir Sınıflandırma

Öz

Hemostaz, doku hasarı sonrasında vasküler bütünlüğü koruyan, vasküler yanıtlar, trombosit aktivasyonu ve pıhtılaşma kaskadı etkileşimlerini içeren karmaşık fizyolojik bir süreçtir. Cerrahi tekniklerdeki ve perioperatif bakımdaki önemli gelişmelere rağmen, intraoperatif ve postoperatif kanamalar modern cerrahide temel zorluklar olmaya devam etmektedir. Sonuç olarak, topikal hemostatik ajanlar basit pasif materyallerden biyolojik olarak aktif, akışkan, mastik bazlı ve rejeneratif platformlara evrilmiştir. Bu derleme, pıhtılaşmanın fizyolojik temeliyle entegre yapılandırılmış bir sınıflandırma çerçevesi aracılığıyla topikal hemostatik ajanlara ve bunların klinik uygulamalarına mekanizma odaklı bir genel bakış sunmaktadır. Günümüzde mevcut olan topikal hemostatik ajanların naratif bir derlemesi yapılmış olup, ajanlar materyal bileşimi, etki mekanizması ve fonksiyonel özelliklerine göre beş ana kategoriye ayrılmıştır: mekanik iskele hemostatik ajanlar, biyolojik olarak aktif hemostatik ajanlar, akışkan hemostatik ajanlar, örtücü/yapıştırıcı hemostatik ajanlar ve gelişmekte olan rejeneratif hemostatik teknolojiler. Mekanik iskele ajanlar rutin kanama kontrolü için temel araçlar olmaya devam ederken, biyolojik olarak aktif ve akışkan hemostatlar karmaşık kanama ortamlarında artmış etkinlik sunar. Örtücü ve yapıştırıcı hemostatlar işlevselliği hemostazın ötesine taşıyarak doku takviyesi ve sızıntı önlemeye kadar genişletir. Gelişmekte olan rejeneratif teknolojiler, kanama kontrolünü doku onarımı ile entegre edebilecek gelişen bir sınırı temsil etmektedir.

Anahtar Kelimeler

• Topikal hemostatik ajanlar
• hemostaz
• cerrahi kanama
• pıhtılaşma kaskadı

Destekleyen Kurum

Bu makalenin yayına hazırlanması kısmen Türk Nöroşirürji Derneği tarafından desteklenmektedir.

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