{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:44:04Z","timestamp":1787330644601,"version":"build-2736575974"},"reference-count":163,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016387","name":"Grifols","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100016387","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Fibrinogen is an essential component of hemostasis and clot formation that stabilizes the platelet-dependent primary hemostatic process. Low fibrinogen levels can be primary (congenital) or secondary (acquired). Acquired hypofibrinogenemia may result from chronic diseases (e.g., liver, autoimmune diseases, and malignancies) or major hemorrhage (e.g., trauma, surgery). Low fibrinogen levels are both a symptom and a precipitating factor for coagulopathy and ongoing bleeding. Fibrinogen repletion with fibrinogen-containing products is important for managing coagulopathic bleeding with suspected or documented hypofibrinogenemia. Different available fibrinogen sources include fibrinogen concentrate, cryoprecipitate, and frozen plasma and vary based on multiple factors including fibrinogen content, purity, other clotting or non-clotting proteins (e.g., immunomodulating proteins or proteins of unknown function), preparation time, safety, volumes, and availability. Fibrinogen replacement strategies have been studied in trauma but also in patients undergoing spine, cytoreductive, and cardiac surgery. In this review, we discuss the physiological actions of fibrinogen, strategies for control of coagulopathic bleeding related to hypofibrinogenemia, and the therapeutic, logistical, and economic factors that influence treatment decisions. In addition, current guidelines and clinical studies were considered regarding the formation of evidence-based treatment strategies that can be individualized at the patient\u2019s bedside.<\/jats:p>","DOI":"10.3390\/jcm15166156","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:00:43Z","timestamp":1786118443000},"page":"6156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fibrinogen Concentrate in Acute Hemorrhage: Mechanistic Insight, Thresholds, and Targeted Replacement"],"prefix":"10.3390","volume":"15","author":[{"given":"Niels","family":"Rahe-Meyer","sequence":"first","affiliation":[{"name":"Clinic for Anesthesiology and Intensive Care Medicine, Franziskus Hospital, 33615 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justyna","family":"Bartoszko","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada"},{"name":"Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3766-4962","authenticated-orcid":false,"given":"Jerrold H.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care Medicine, and Surgery (Cardiothoracic), Duke University School of Medicine, Durham, NC 27710, USA"},{"name":"The Centre for Blood Research, University of British Columbia, Vancouver, BC V6T 1Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1111\/trf.12431","article-title":"Fibrinogen as a therapeutic target for bleeding: A review of critical levels and replacement therapy","volume":"54","author":"Levy","year":"2014","journal-title":"Transfusion"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3324\/haematol.2019.236901","article-title":"Fibrin(ogen) in human disease: Both friend and foe","volume":"105","author":"Vilar","year":"2020","journal-title":"Haematologica"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/978-3-319-49674-0_13","article-title":"Fibrin Formation, Structure and Properties","volume":"82","author":"Weisel","year":"2017","journal-title":"Subcell. 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