Blood conservation strategies in liver transplantation: Past, present, and future

Table 5 Topical and mechanical hemostatic agents

Sub-class	Works on	Feature	Limitation	Ref.
Fibrin-based liquid adhesives: Tisseel, evicel	Broad oozing surfaces, vascular anastomoses, coagulopathic patients	Provide fibrinogen + thrombin: Fibrin clot formation	Air embolism with spray, intravascular thrombosis, viral transmission risk	[130,131]
Fibrin patches/sponges: TachoSil, evarrest, fibrin pad	Severe bleeding, liver resection, cardiac surgery	Adhesive + mechanical scaffold prevents streaming effect	Severe bleeding, liver resection, cardiac surgery	[132-135]
Thrombin-only agents: Human thrombin, bovine thrombin, recombinant thrombin	Adjunct to surgical hemostasis	Converts fibrinogen to fibrin	Immunogenicity, thrombosis, viral risk (plasma-derived)	[13,137]
Flowable gelatin and thrombin: Floseal, surgiflo	Rapid hemostasis across specialties	Mechanical matrix + active clot formation	Swelling, infection, compression injury	[138-141]