A Comprehensive Review on the Hemostatic Properties of Metal-based Materials and Substances.

Uncontrolled hemorrhage, caused by various factors, represents a significant medical challenge with several health implications for patients and a substantial financial burden on the healthcare systems. This issue arises from unmet needs in both clinical and non-clinical sectors due to the limited efficacy of current hemostatic products and approaches in controlling excessive blood loss. Therefore, there are urgent clinical and scientific needs to design and develop new hemostatic materials with desired efficacy, safety, lower cost, and extended storage durability. To date, various synthetic and natural-based materials have been explored for the development of effective hemostatic products in diverse forms and structures. Among these, active inorganic and metal-based components have emerged as promising clinical candidates due to their superior physicochemical properties and performance in hemorrhage control and tissue repair. Regarding the intrinsic and extrinsic roles of metallic substances in hemostasis, we aimed to review and highlight the individual blood coagulation properties of these materials and elucidate their hemostatic mechanisms at the cellular and molecular levels. To this end, the effects of different metals in the course of the hemostasis process were investigated based on previous studies, and the effective factors influencing their hemostatic properties were identified. Finally, the review identifies challenges and outlines future directions for developing innovative metal-based hemostatic agents for rapid and effective hemorrhage management.