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

Table 6 Topical synthetic hemostatic agents

Sub-class	Works on	Feature	Limitation	Ref.
Cyanoacrylates (Octyl-2, Butyl-2)	Moisture-induced polymerization forming tissue adhesion	Rapid sealant, waterproof, sutureless closure; used for skin wounds and variceal embolization	Embolic risk if intravascular; toxic degradation products; unsuitable for mucosa, joints, avulsed tissue, or vascular anastomoses	[142-144]
Microporous polysaccharide hemospheres	Absorb fluid to concentrate platelets and clotting proteins	Accelerates endogenous clotting; reduces time to hemostasis	Ineffective in severe coagulopathy; limited efficacy in high-pressure bleeding	[145]
PEG hydrogel (CoSeal)	Cross-linked hydrogel sealing tissue planes	Sealant and anti-adhesion barrier; non-exothermic, low inflammation; reduces pericardial adhesions	Swelling may compress adjacent structures; poor adhesion to renal parenchyma	[146]
Glutaraldehyde cross-linked albumin (BioGlue)	Protein cross-linking forming rigid adhesive scaffold	Strong adhesion to tissue and synthetic grafts; useful in vascular/cardiac surgery	Tissue toxicity, stenosis risk; avoided in young patients	[147-149]
Synthetic hemostatic nanomolecules	Cationic interaction enhances platelet aggregation	Rapid hemostasis in experimental liver and trauma models	Predominantly preclinical; limited human safety data	[149-151]