Topical hemostatic powders in the management of gastrointestinal bleeding

Hemostatic powders were developed to overcome limitations associated with conventional endoscopic techniques, and their use in gastrointestinal bleeding is increasing exponentially. Various hemostatic powder preparations exist, each differing in properties, efficacy, and potential side effects. In this study, we aimed to review three representative hemostatic powders approved by the FDA (U.S. Food and Drug Administration). A literature review of hemostatic powders used for gastrointestinal bleeding was conducted via a MEDLINE database search, supplemented by manual article searches spanning from 2000 to 2024. Relevant literature was critically evaluated, focusing on key components, hemostatic efficacy, rebleeding rates, and adverse events. Hemospray and Endoclot are the most extensively studied hemostatic powders, demonstrating successful applications across a wide spectrum of upper and lower gastrointestinal bleeding etiologies. Nexpowder, a newer agent, has shown comparable efficacy to these established powders in early clinical studies. All three powders achieve high immediate hemostasis rates, particularly beneficial in cases where conventional endoscopic methods are challenging. Nevertheless, notable limitations remain, including reduced effectiveness in cases of active arterial spurting hemorrhage (Forrest Ia) and ongoing concerns regarding rebleeding rates. Adverse events such as visceral perforation, venous embolism, and transient abdominal pain have been documented with Hemospray. Conversely, no agent-related adverse events have yet been reported for Nexpowder and Endoclot. Recent studies have begun investigating whether hemostatic powders offer additional benefits in reducing post-procedural rebleeding and major upper gastrointestinal bleeding. The rapid advancement of hemostatic powders and accumulating clinical experience affirm these agents as valuable therapeutic options in gastrointestinal bleeding management. Ongoing research is crucial to further enhance their efficacy and extend their clinical applicability.