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

Table 7 External hemostatic dressings

Sub-class	Works by	Feature	Limitation	Ref.
Fibrinogen-based dressings	Direct fibrin clot formation independent of host coagulation	Effective even in hypothermia and coagulopathy; useful for open wounds	Limited availability; biological product considerations	[152]
Zeolite-based dressings (QuikClot®, ACS)	Absorb water to concentrate clotting factors and cells	Rapid hemostasis in trauma; effective in junctional hemorrhage	Exothermic reaction; thermal injury, difficult removal, ineffective in arterial bleeding	[153-155]
Clay-based dressings	Surface charge–mediated activation of intrinsic pathway	Thermally stable; high surface area, ion exchange capability	Variable swelling, material-specific inflammatory risk	[156]
Kaolin-based dressings (QuikClot Combat Gauze®)	Contact activation of intrinsic coagulation (factors XII, XI)	No exothermic injury; strong clinical evidence; standard military use	Limited efficacy in massive arterial bleeding	[157]
Smectite-based dressings (e.g., WoundStat®)	Water absorption and intrinsic pathway activation	High absorption, swelling, and viscosity; effective hemostasis	Severe inflammation, tissue necrosis; difficult removal; withdrawn from use	[158]
Chitin/chitosan-based dressings	Electrostatic interaction with erythrocytes and platelets (coagulation-independent)	Effective in coagulopathy, antimicrobial, biocompatible	Expensive; shellfish allergy concern; requires training for optimal use	[159,160]
Polyelectrolyte complexes (chitosan-based PECs)	Electrostatic polymer interactions accelerating coagulation	Rapid clotting; antimicrobial activity; good tissue compatibility	Largely experimental; limited human clinical data	[161]
Chitosan bandages (HemCon®)	Mechanical sealing and tissue adhesion	Proven antimicrobial properties	Requires hands-on training, adhesion may be difficult in emergencies	[162]