Hemostatic Sponge With Excellent Wet Tissue Adhesion Performance for Anticoagulant-Associated and Unsuturable Visceral Hemorrhage Management.

The management of uncontrolled hemorrhage in anticoagulant-associated patients and visceral trauma necessitates hemostatic agents that operate independently of classical coagulation pathways. Herein, we report a gelatin sponge patch by one-sided coating with N-hydroxysuccinimide (NHS) ester-functionalized poly (acrylic acid-co-N-succinimidyl acrylate) (PANS), which acts by formation of covalent and hydrogen bonding cross-links between polymer, blood proteins, gelatin, and tissue to seal the wound site and prevent hemorrhage during surgery. PANS exhibits robust lap-shear strength of up to 114.4 ± 8.7 kPa, enabling the PANS-GS composite to achieve effective wet-tissue adhesion, while macroporosity is preserved for rapid blood absorption. This dual-function design allows simultaneous physical sealing and platelet enrichment with reduced dependence on fibrin-mediated coagulation pathways. In rat hepatic laceration and femoral artery injury models, the composite sponge demonstrates superior hemostatic efficacy, with significant reductions in bleeding time and blood loss compared to clinically used sponges in both non-heparinized and systemically heparinized subjects. Critically, biocompatibility assessments reveal minimal cytotoxicity and hemolysis, while histopathological analysis indicates no significant increase in inflammatory response compared with commercial gelatin sponge. These results establish a coagulation-independent hemostatic strategy that integrates strong wet adhesion with preserved porosity, offering promise for managing anticoagulant-associated bleeding, visceral trauma, and complex battlefield injuries.