An efficient hemostatic hydrogel patch enabled by TXA-induced rapid wet adhesion and release

Non-compressible hemorrhage remains the leading cause of death in combat injuries and severe trauma. Herein, we developed a wet-adhesive drug-releasing hydrogel (WAR) based on tranexamic acid (TXA), which synergistically stops bleeding through TXA surface enrichment, rapid swelling, strong wet tissue adhesion, and antifibrinolytic effects. WAR enables rapid gelation, fast water absorption, strong wet-tissue adhesion, and simultaneous activation of coagulation and tissue repair pathways—promoting platelet activation, accelerating the coagulation cascade, and initiating early repair. In five rat models of non-compressible hemorrhage, WAR outperformed commercial GS® and CS® chitosan hemostatic gels. WAR can be detached on demand with low-concentration urea, without tissue damage. Additionally, WAR accelerates full-thickness skin healing, promotes M2 macrophage polarization, angiogenesis, and ordered collagen remodeling, and achieves near-scarless functional wound healing in 10 days. This work presents a TXA spatial rearrangement–driven strategy for designing hemostatic hydrogels against non-compressible hemorrhage.