The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists have updated their 2007 blood conservation clinical practice guidelines

Updated Topics
1.Preoperative management of dual anti-platelet treatment
2.Pharmacotherapy to increase red blood cell volume or to reduce blood loss
3.Use of blood derivatives, eg, fresh frozen plasma, factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant factor VII, antithrombin III, and factor IX concentrates
4.Updated strategies to manage blood salvage
5.Use of minimally invasive procedures to reduce perioperative bleeding and need for blood transfusion
6.Strategies for blood conservation associated with extracorporeal membrane oxygenation and cardiopulmonary perfusion
7.Use of topical agents for hemostasis
8.Optimal usefulness of team interventions in blood management.

Changes to Previous Guidelines

• Blood conservation should start with preoperative risk evaluation.
• Measures to reduce hemodilution and conserve preoperative patient red cell volume
• Patients with heparin-induced thrombocytopenia who are receiving extracorporeal membrane oxygenation should be anticoagulated with nonheparin anticoagulant therapies
• Before surgery, antiplatelet and anticoagulant drug therapy should be identified and managed.
• Use of blood derivatives may facilitate blood management in patients with serious bleeding who have multiple or single coagulation factor deficiencies.
• Leukoreduced donor blood, if available, should be used when allogeneic blood transfusion is needed. Intraoperative platelet plasmapheresis may help conserve blood as part of a multimodality program in high-risk patients if an adequate platelet yield can be reliably obtained.
• To manage intractable nonsurgical bleeding after cardiac procedures using cardiopulmonary bypass, use of recombinant factor VIIa concentrate may be considered.
• Blood salvage interventions may include centrifugation of salvaged blood from the operative field in high-risk patients with known malignant disease who require cardiopulmonary bypass.
• Adjunctive topical interventions, such as topical hemostatic agents or antifibrinolytic agents poured in the surgical wound, may be useful to supplement local hemostasis achieved by good operative technique.
• To reduce blood product utilization, minimally invasive procedures, particularly implantation of aortic endografts for aortic disease, should be used.
• In a select group of patients undergoing coronary revascularization without the use of cardiopulmonary bypass, off-pump procedures can limit bleeding and blood transfusion, but because of concerns regarding graft patency, evidence supporting routine off-pump coronary revascularization for blood conservation during coronary revascularization is less robust vs that for aortic endografts.
• An important facet of blood conservation is the management of blood resources, preferably by a multidisciplinary team made up of a broad base of stakeholders.

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