Medical hemostatic sealants have been widely used in trauma surgery, which can greatly reduce intraoperative bleeding and postoperative complications, thereby improving the surgical effect. However, for patients receiving oral anticoagulants, medical sealants must have higher requirements. They can stop bleeding under anticoagulant conditions, and the hemostatic materials are safe and easy to remove. In addition, they should also have a certain price advantage.
At present, fibrin glue is mainly used in clinical hemostasis of traumatic organs. The principle of hemostasis mainly relies on prothrombin and fibrinogen, while anticoagulants such as heparin can easily interfere with or quench thrombin, so that fibrin glue cannot meet the hemostasis of anticoagulant patients.
The aminolysis-based four-arm polyethylene glycol hydrogel is an excellent hemostatic sealant (ACS Applied Materials & Interfaces 2016, 8, 12674-12683). It has high strength, certain tissue adhesion, and can stop hemostasis through physical occlusion. It is not affected by anticoagulants. It also has a price advantage. However, the current four-arm polyethylene glycol hydrogel based on the aminolysis reaction cannot be degraded quickly, and it will stay in the organ hemostasis for a long time, resulting in foreign body reaction, delaying wound healing, and even blocking the human circulatory system.
In view of this, the research group of Wu Decheng, a researcher at the Institute of Chemistry of the Chinese Academy of Sciences, and the research group of Tang Peifu, director of the Department of Orthopedics of the Chinese People's Liberation Army General Hospital, have jointly developed a four-arm polyethylene glycol medical sealant (SS) based on the succinyl ester structure to solve the problem of hemostasis in patients with oral anticoagulants after orthopedics or interventional surgery. The related paper was recently published in the journal Advanced Materials under the title Tetra-PEG Based Hydrogel Sealants for in vivo Visceral Hemostasis (Adv. Mater. 2019, 31, 1901580).
The hydrogel has a rapid gel formation, strong tissue adhesion and high mechanical strength, which is superior to the currently reported polyethylene glycol hydrogels and fibrin glues (Fig. A). More importantly, compared with the traditional glutaryl ester-based four-arm polyethylene glycol gel (SG), the SS sealant can degrade rapidly. The mechanism of its occurrence is proved by simulated means that the nucleophilic attack within the molecule leads to the cyclization of the succinyl ester. The SS sealant can be dissolved in cysteamine solution for 30 minutes. The SS sealant located in the tissue pores can be removed within 5 minutes using a cotton swab-infiltrated erase solution. Subcutaneous and muscle implantation experiments demonstrate that SS has excellent biocompatibility and does not cause long-term foreign body reactions. This novel SS sealant is able to rapidly stop bleeding in situ in a heparinized model of Bama pig spleen hemorrhage (Fig. B). After hemostasis is completed, due to its excellent degradability and biocompatibility, SS can promote wound healing faster than traditional SG gels and gauze without causing side effects.
The new polyethylene glycol-based hydrogel has excellent hemostatic properties and safety, and can be used for anticoagulant bleeding where fibrin glue cannot stop bleeding. It is expected to be a simple, effective and safe sealant for traumatic in vivo hemostasis.
Institute of Chemistry and others to develop a new type of polyethylene glycol-based hydrogel for hemostatic closure of traumatic organ injury
Source: Institute of Chemistry, Chinese Academy of Sciences
