Fibrillar Cellulose-Based Hemostatic Agents for Intraoperative Bleeding Control: A Comparative Analysis of the Physical and Chemical Properties

Background: The selection of the optimal hemostatic agent for surgical procedures remains a subject of ongoing debate. Among topical hemostatic agents, cellulose-based hemostats constitute a significant class of biocompatible and bioabsorbable polymers, widely recognized for their superior performance and broad range of medical applications. Fibrillar cellulose-based hemostatic agents, derived from natural plant sources, enhance platelet adhesion and play a critical role in hemostasis by activating both the intrinsic and extrinsic clotting cascades; they differ significantly in their physical structure, handling characteristics, and best clinical application from the classical cellulose-based hemostatic agents. Their versatility and efficacy have led to widespread use across various surgical specialties. Methods: This study aimed to compare the physicochemical properties of three commercially available fibrillar oxidized regenerated cellulose (ORC) hemostatic agents. Specifically, key parameters influencing their clinical performance, such as swelling capacity, degradation rate, absorption capacity, and pH levels, were evaluated. Additionally, expert assessments were conducted to analyze the intraoperative handling properties of these agents during surgical procedures. Results: The findings revealed that operative handling scores were broadly comparable among the three products tested, as all fibrillar ORC hemostats readily conformed to irregularly shaped cavities and adhered well to the application site. However, differences were observed in their swelling, pH, absorption, and dissolution properties. Surgicel Fibrillar showed the lowest swelling (25%, vs. 40% for Pahacel Fibril and 65% for Equitamp Fibrillar) and the lowest pH values, and was completely dissolved in vitro by day 7, whereas Pahacel Fibril and Equitamp Fibrillar remained visible at day 31; Pahacel Fibril absorbed the test solution more slowly than the other two products. Conclusions:These in vitro results provide information on the physicochemical and handling characteristics of three fibrillar ORC hemostatic agents, including their swelling, absorption, pH, and dissolution behavior, which may be relevant to product selection. Differences in physical properties should not be interpreted as differences in clinical hemostatic efficacy, which was not assessed in this study.