Abstract
Fibrinogen is a final substrate in fibrin polymerization. The subsequent firm blood clot is a key factor in secondary hemostasis, and anti-plasmin therapy plays an important role in protecting blood clots from fibrinolysis. Fibrinogen replacement therapy has been widely used to treat critical bleeding. An increase in the minimum level of fibrinogen concentration is consistent with the invention and propagation of thromboelastometry (ROTEM®) around the world. Cardiovascular surgery with cardiopulmonary bypass has an important pathophysiology of coagulation in consideration with fibrinogen replacement therapy. It would provide a good reference for perioperative critical bleeding and trauma. In view of current hemostatic therapy, we discuss effective hemostasis and appropriate blood transfusion by the combined assessment of fibrinogen concentration and fibrin polymerization (Fuji-san classification). We also consider future perspectives.
