Key Criteria of Hemostatic Efficiency of Highly Porous Cellulose-Based Scaffolds: A Review

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Abstract
Introduction. Severe bleeding and uncompensated blood loss remain some of the most serious complications associated with trauma and surgical interventions that can threaten life. In recent years, intensive research has been directed toward developing hemostatic materials based on natural and synthetic polymers. Among them, cellulose and its modified derivatives represent one of the most promising sources for creating effective hemostatic systems. The aim of this review was to identify key criteria for the efficiency of cellulose-based gels with hemostatic activity. Methods. Experimental studies aimed at evaluating new hemostatic materials were analyzed based on international sources using the PRISMA methodology. Results. A total of 111 publications were identified. Following the identification and screening stages, 20 articles were selected for the final qualitative synthesis. The analyzed publications include experimental studies focused on the development and analysis of highly porous cellulose-based scaffolds in the form of aerogels and cryogels. The type and origin of cellulose, as well as the influence of additional components and synthesis conditions on gel formation, were investigated. Discussion and Conclusions. Three major groups of key criteria that should be considered when developing new cellulose-based highly porous scaffolds with hemostatic functionality were identified: (I) physicochemical and mechanical properties (pore size distribution, compressive strength, and presence of functional groups); (II) in vitro tests (blood clotting index, red blood cell adhesion rate, hemolysis, cytocompatibility, and antibacterial activity); (III) in vivo hemostatic efficiency (hemostasis time and blood loss) in compliance with the 3Rs policy (replacement, reduction, refinement).
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