Fig. 1.

Coagulation support in perioperative bleeding management. The goal of coagulation support during perioperative bleeding management is to promote clot formation. Components of primary clot formation are fibrinogen which is supplemented by fibrinogen concentrate and/or cryoprecipitate, platelets which can be supplemented by platelet transfusion and activated by calcium supplementation. For secondary coagulation processes, calcium, plasma transfusion, and prothrombin complex concentrate administration promote thrombin and fibrin formation, further stabilizing clot formation. Of note, cryoprecipitate contains more FXIII than most of the fibrinogen concentrates. By thrombin activated FXIII crosslinks fibrin monomers to create a fibrin polymer network. Red blood cells by changing their shape further empower the stabilization of the clot. There is some evidence that plasma transfusion, next to coagulation factor supplementation, also protects endothelial glycocalyx release, limiting excessive clot formation. Finally, tranexamic acid by binding lysine groups of plasminogen limits the transversion of plasminogen into plasmin, reducing the fibrinolysis reaction