Patient blood management programs use a multimodal approach to conserve blood and simultaneously improve patient outcomes. Transfusion guidelines are central to blood management, and such guidelines for high-risk surgery patients, particularly cardiothoracic patients, have recently been updated for the first time since 2011. A multidisciplinary team comprising the Society of Thoracic Surgeons, Society of Cardiovascular Anesthesiologists, American Society of ExtraCorporeal Technology, and the Society for the Advancement of Blood Management reviewed relevant transfusion literature to inform the guidelines. The team made 23 new or updated recommendations. Highlighted major recommendations include use of synthetic antifibrinolytics (namely ε-aminocaproic acid or tranexamic acid) to promote blood clotting during surgery. Restrictive transfusion strategies are recommended over liberal strategies for most patients to conserve blood resources. Transfusion algorithms based on point-of-care tests are recommended to reduce periprocedural bleeding and transfusion. Finally, for elective surgeries, antiplatelet blood thinners should be stopped for a minimum of three days for ticagrelor, 5 days for cloidogrel, and 7 days for prasugrel. For low-intensity antiplatelet drugs such as aspirin, they recommend discontinuing the drug before operations only for elective patients without acute coronary syndromes. Although these guidelines were developed for cardiac surgery patients, they are likely applicable for other high-risk surgery patients.
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