How I Treat How I use fibrinogen replacement therapy in acquired bleeding

Fibrinogen is a critical protein for clot formation, providingamatrix and mesh network essential for clot strength. Maintaining fibrinogen levels is an important therapeutic target in bleeding patients, particularly in perioperative settings. Early studies demonstrated that fibrinogen repletion corrected clot strength, based on viscoelastic blood testing using thromboelastography/thromboelastometry. Normal fibrinogen levels are elevated during pregnancy, and cases studies indicate that fibrinogen repletion may be effective in the treatment of postpartum hemorrhage. Additionally, studies have been published, or are underway, that provide supporting evidence for the role of fibrinogen repletion for treating acquired coagulopathy. Although precise levels for fibrinogen repletion remain to be defined as a therapeutic trigger or target, we review the current evidence and provide therapeutic perspectives in clinical settings.