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Shangyi Hui and Qianyu Zhuang

TO THE EDITOR: We read with great interest the article by Naik et al. 5 (Naik BI, Pajewski TN, Bogdonoff DL, et al: Rotational thromboelastometry–guided blood product management in major spine surgery. J Neurosurg Spine 23: 239–249, August 2015), in which the case-control study identified hypofibrinogenemia as an important cause of the coagulopathy in major spine surgeries and indicated that rotational thromboelastometry (ROTEM)–guided transfusion would allow for early identification and treatment of hypofibrinogenemia, thereby reducing the intraoperative