Adhesive Hemostatic Hydrogel with Ultrafast Gelation Arrests Acute Upper Gastrointestinal Hemorrhage in Pigs

Upper gastrointestinal (GI) hemorrhage is a common clinical emergency worldwide. Endoscopic hemostasis is the current first line treatment. Nevertheless, for patients with severe active bleeding and challenging anatomy, endoscopic management can be still difficult and usually requires a higher level of surgical expertise. A simple and effective method of endoscopic hemostasis is therefore in acute clinical demand. Herein a hemostatic hybrid hydrogel comprised of hyaluronic acid and polyethylene glycol stabilized by thiourea-catechol coupling and disulfide bonds is reported. The hybrid hydrogels exhibit enhanced mechanical properties, short gelation time, and good blood clotting ability compared with fibrin gels. The in vivo hemostatic efficacy is confirmed in a rat model of arterial bleeding, in which the rapid gelation of hybrid hydrogels after topical application effectively arrests blood loss with no rebleeding occurring during resuscitation when blood pressure approximately recovers to normal. A large animal study further demonstrates the efficacy of hybrid hydrogels to achieve endoscopic hemostasis against upper GI hemorrhage in pigs. Follow-up observations show that the hybrid hydrogels can remain adherent at the bleeding wound for 48 h, indicating the sustained hemostatic function in vivo. Collectively, this work demonstrates a promising hemostatic hydrogel for endoscopic hemostasis in upper GI hemorrhage.

Automated summary

A novel hemostatic hybrid hydrogel comprised of hyaluronic acid and polyethylene glycol stabilized by thiourea-catechol coupling and disulfide bonds is reported for endoscopic hemostasis in upper GI hemorrhage. The hybrid hydrogels exhibit enhanced mechanical properties and good blood clotting ability, showing promising results in both rat and pig models. The sustained hemostatic function of the hybrid hydrogels make them a potential candidate for clinical applications in endoscopic hemostasis.