Fibrinogen Replacement: A Questionable Dogma

Area of Science:

• Coagulation science
• Clinical hemostasis management
• Evidence-based medicine

Background:

• Hemostasis management has significantly advanced in the last 20 years.
• Viscoelastic testing and single-factor replacement therapies are now standard clinical practices.
• These advancements impact perioperative care, trauma, and acute care settings.

Purpose of the Study:

• To review the fundamental principles of viscoelastic assays and single-factor replacement therapies.
• To examine the supporting scientific evidence for these hemostasis management approaches.
• To emphasize the importance of evidence-based application in clinical practice.

Main Methods:

• Review of current literature and clinical guidelines.
• Analysis of evidence supporting viscoelastic testing (e.g., TEG, ROTEM).
• Evaluation of evidence for single-factor replacement therapies in bleeding management.

Main Results:

• Viscoelastic assays provide rapid, comprehensive hemostasis assessment.
• Single-factor replacement therapies allow targeted correction of specific coagulation deficiencies.
• Both modalities have demonstrated significant benefits when used appropriately.

Conclusions:

• Viscoelastic testing and single-factor replacement therapies represent major improvements in hemostasis management.
• The application of these techniques should be guided by robust scientific evidence.
• Optimizing patient outcomes requires a thorough understanding of the underlying principles and evidence.