Clinically, safe and effective hemostatic irrigants are of vital importance, particularly in neurosurgical operations where physical instruments and solid hemostatic materials are not applicable. However, conventional H₂O₂ irrigation poses risks of tissue injury, gas embolism and neuronal damage, while over-administration of thrombin solutions may induce systemic hazards including thrombosis. Herein, we reveal that plasma-activated water (PAW), which is produced exclusively from air and water, functions as a highly efficient and biosafe hemostatic irrigant. Short-lived reactive species in PAW—particularly ONOO^-, O₂^-, and ¹O₂—drive robust pro-coagulant activity. Mechanistically, these species synergistically enhance platelet activation, degranulation, and aggregation, while accelerating the coagulation cascade via rapid thrombin generation and fibrin cross-linking. In contrast, PAW accelerates blood coagulation by 28.8% compared to commonly-used 1% H₂O₂ irrigation unlike exogenous thrombin solutions, and also exhibits inherently self-limiting pro-coagulant activity which can effectively eliminating the risk of distal thrombosis. In rat models, PAW shortens hemostasis times by 50.5% in tail amputations and by 77.3% in cerebral cortex hemorrhages, while significantly mitigating inflammation and tissue damage compared to H₂O₂. Our findings elucidate a previously unrecognized role for plasma-generated reactive species in blood coagulation, presenting PAW as a promising and safe alternative for intraoperative hemostatic irrigation.
 

plasma-activated water,hemostasis,coagulation cascade,blood platelet,ONOOH,cerebral cortex hemorrhages,H2O2