Emerging haemostatic sprays: From material design to clinical translation.

Haemostatic sprays have emerged as a transformative class of topical agents for the rapid control of bleeding in surgery, trauma, and endoscopy, particularly in settings where conventional approaches such as suturing, cauterisation, or mechanical compression are impractical. Delivered in a non-contact and conformal manner, these systems enable efficient coverage of irregular, deep, and non-compressible bleeding sites. Their haemostatic action arises from synergistic biochemical and physical mechanisms, including activation of the coagulation cascade, plasma absorption driven concentration of clotting factors, and formation of adhesive or barrier-type matrices at the wound surface. Commercial and non-commercial products such as Hemospray®, PuraStat®, Raplixa™, Ankaferd Blood-Stopper®, EndoClot®, OOZFIX™, and CMCS-COHA have demonstrated clinically meaningful reductions in bleeding, improved procedural visibility, and favourable patient outcomes across gastrointestinal, surgical, and trauma indications. Alongside these, a rapidly expanding portfolio of pre-clinical sprayable biomaterials spanning mineral, polysaccharide, protein, peptide, hydrogel, and nano-engineered platforms offers new opportunities to address unmet needs in non-compressible and complex haemorrhage. This review provides a comprehensive and integrated analysis of haemostatic sprays, covering material classes, mechanisms of action, clinical applications, and translational performance. Key challenges, including tissue irritation, thromboembolic risk, impaired visualisation, and limitations in adhesion or durability, are critically examined, together with emerging strategies to improve biocompatibility, targeting accuracy, and suitability for pre-hospital or low-resource settings. By synthesizing current clinical evidence with advances in biomaterial design and spray-delivery technologies, this review defines the present capabilities of haemostatic sprays and outlines a roadmap for their next-generation development. These innovations are poised to further enhance the safety, speed, and effectiveness of bleeding control in modern surgical and emergency care.