Advancements in Fibrinogen Replacement for Major Bleeding: Insights From Case Series

This case series explores the role of fibrinogen replacement in managing major bleeding across cardiac, obstetric, and trauma contexts. Acquired fibrinogen deficiency (AFD) frequently complicates hemostasis during major bleeding by impairing clot stability. We examine three cases where fibrinogen is repleted with fibrinogen concentrate (FC) or pathogen-reduced cryoprecipitate, rather than cryoprecipitate, to manage perioperative bleeding in cardiac surgery, postpartum hemorrhage, and trauma-induced coagulopathy. These cases underscore the need for timely fibrinogen replacement in critical bleeding situations, highlighting potential clinical benefits of rapid repletion of fibrinogen, and, in addition, we review ideal treatment options based upon viscoelastic testing (VET).