2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines

Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis

“…A protocol was developed (eAppendix pg 21) that was restricted to RCTs and observational studies of transfusion in cardiac surgery, but because current transfusion guidelines 4,5 are also based on RCTs in non-cardiac surgical patients, we subsequently decided to include these in this systematic review. Despite the limitations of comparing different study designs, we chose to compare RCTs and observational studies as these are the evidence base for current guidelines.…”

“…The decision to transfuse is complicated by several factors; severe anaemia and excessive blood loss are common in this setting 1,2 , and patients with cardiovascular disease have different transfusion requirements to other patient groups 3 . Transfusion decisions in cardiac surgery are most commonly based on the severity of perioperative anaemia: guidelines currently recommend (Grade C recommendation) highly restrictive transfusion thresholds with Haemoglobin (Hb) concentrations of 6-7g/dL 4,5 . These are based largely on the results of RCTs in non-cardiac surgery patients that indicate equivalence for restrictive transfusion thresholds [6][7][8] .…”

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

“…Current practice guidelines support incorporating near‐patient coagulation testing into blood management algorithms for cardiac surgery 24, 25, 26. However, these guidelines do not distinguish between the use of near‐patient tests to inform treatment selection after patients develop severe bleeding, and the use of pre‐emptive testing to predict bleeding and to direct preventative treatments.…”

“…Blood management algorithms incorporating near‐patient tests are recommended in US and European practice guidelines24, 25, 26, and are used widely 27. However, there is poor consensus about the best algorithm design, particularly whether near‐patient tests should be performed in response to severe bleeding, or whether there is additional value in pre‐emptive testing to help prevention of bleeding.…”

To Pretreat or Not to Pretreat (With Oral P2Y12 Antagonists)? That is the Question

“…Guidelines currently recommend that P2Y12 inhibitor therapy should be held for at least 5 days for clopidogrel or ticagrelor and 7 days for prasugrel before surgery (Class I, Levels of Evidence B and C, respectively). However, the guidelines also provide the recommendation that it is reasonable to perform surgery before these time points, and perhaps as early as 3 days from discontinuation 1, 15. These guidelines stem from the inherent properties of each medication, including their metabolism and clearance.…”