Background. Practice guidelines reflect published liter-ature. Because of the ever changing literature base, it isnecessary to update and revise guideline recommenda-tions from time to time. The Society of Thoracic Surgeonsrecommends review and possible update of previouslypublished guidelines at least every three years. Thissummary is an update of the blood conservation guide-line published in 2007.
Routine addition of P2Y12 inhibitors to aspirin therapy early after coronary artery bypass graft （CABG） mayincrease the risk of reexploration and subsequent operation and is not indicated based on availableevidence except in those patients who satisfy criteria for ACC/AHA guideline-recommended dualantiplatelet therapy （eg, patients presenting with acute coronary syndromes or those receiving recentdrug eluting coronary stents）。
It is reasonable to use preoperative erythropoietin （EPO） plus iron, given several days before cardiacoperation, to increase red cell mass in patients with preoperative anemia, in candidates for operation whorefuse transfusion （eg, Jehovah's Witness）， or in patients who are at high risk for postoperative anemia.However, chronic use of EPO is associated with thrombotic cardiovascular events in renal failure patientssuggesting caution for this therapy in individuals at risk for such events （eg, coronary revascularizationpatients with unstable symptoms）。
Recombinant human erythropoietin （EPO） may be considered to restore red blood cell volume in patientsalso undergoing autologous preoperative blood donation before cardiac procedures. However, no large-scale safety studies for use of this agent in cardiac surgical patients are available, and must be balancedwith the potential risk of thrombotic cardiovascular events （eg, coronary revascularization patients withunstable symptoms）。