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January 25, 2024 — In a groundbreaking development, a team of researchers at Brigham and Women’s Hospital has unveiled a novel hemostat that effectively stops bleeding within an average of five minutes, even in patients on anticoagulation or antiplatelet medications. The findings, published in the Proceedings of the National Academy of Sciences (PNAS), mark a significant advancement in strategies to minimize blood loss during medical procedures, presenting a potential life-saving solution.
More than 11 million people in the United States alone rely on anticoagulation or antiplatelet medications to address critical conditions such as heart attacks and strokes. However, these medications pose a serious risk of life-threatening bleeding, especially during surgery or injury. The newly developed hemostat aims to revolutionize blood clotting mechanisms and significantly reduce the time required to control bleeding.
Lead author Hae Lin Jang, Ph.D., explained, “This is a next-generation hemostat that effectively stops bleeding, even in patients who take anticoagulation or antiplatelet medications. We used an exciting, interdisciplinary approach that combines engineering principles, materials science, and understandings of molecular biology to overcome the limitations of existing therapies and address a real clinical need.”
The research team employed a “rational engineering” approach, simulating blood flow through pores to determine the optimal microscopic design for absorption. Taking inspiration from the architecture of human lungs, which have alveoli facilitating high interaction rates with blood, the researchers engineered a highly interconnected, spherical microporous structure for their hemostat. This structure rapidly absorbs blood and accumulates clotting components, enhancing the body’s natural blood clotting mechanisms.
The material, created using chitosan extracted from shellfish, exhibited remarkable efficacy. The positively charged surface of chitosan attracted negatively charged platelets and fibrinogen, crucial components of blood clots. Contrary to previous assumptions, the researchers discovered that chitosan also directly stimulates blood clotting by activating the TLR-2 clotting pathway, making it particularly effective for patients on anticoagulants.
In a study involving 70 patients undergoing cardiovascular catheterization procedures while on the anticoagulant heparin, the hemostat demonstrated swift results. Bleeding halted within an average of five minutes for patients on low-dose heparin and under nine minutes for those on heparin doses of up to 12,500 IU.
The hemostatic material offers additional advantages, including easy application and removal. Unlike traditional compression methods that can take hours and cause patient discomfort, the chitosan pad eliminates the need for prolonged compression and is removed cleanly with minimal patient discomfort.
Dr. Vivian K. Lee, the first author of the study, emphasized the potential of the hemostat in emergency situations, stating, “In emergencies, it can be extremely challenging to screen the prescription information of a patient to provide appropriate anticoagulation reversal therapy to patients on anticoagulants. If a hemostat can bypass a medication’s anticoagulating mechanisms, it can be used in a wide range of patients, saving time, and potentially saving lives.”
The researchers are now exploring the broader applications of the hemostat and investigating next-generation wound dressings that could further enhance patient outcomes.
