Coronary artery bypass surgery perioperative bleeding/transfusion



==ACCF/AHA Guidelines for Perioperative Bleeding/Transfusion == {{cquote|

Class I
1. Lysine analogues are useful intraoperatively and postoperatively in patients undergoing on-pump CABG to reduce perioperative blood loss and transfusion requirements. (Level of Evidence: A)

2. A multimodal approach with transfusion algorithms, point-of-care testing, and a focused blood conservation strategy should be used to limit the number of transfusions. (Level of Evidence: A)

3. In patients taking thienopyridines (clopidogrel or prasugrel) or ticagrelor in whom elective CABG is planned, clopidogrel and ticagrelor should be withheld for at least 5 days          (Level of Evidence: B) and prasugrel for at least 7 days (Level of Evidence: C) before surgery.

4. It is recommended that surgery be delayed after the administration of streptokinase, urokinase, and tissue-type plasminogen activators until hemostatic capacity is restored, if possible. The timing of recommended delay should be guided by the pharmacodynamic half-life of the involved agent. (Level of Evidence: C)

5. Tirofiban or eptifibatide should be discontinued at least 2 to 4 hours before CABG and abciximab at least 12 hours before CABG. (Level of Evidence: B)

Class IIa
1. It is reasonable to consider off-pump CABG to reduce perioperative bleeding and allogeneic blood transfusion. (Level of Evidence: A)}}

Guidelines Resources

 * 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines