The case for a conservative approach to blood transfusion management in cardiac surgery

Tyler Gunn, Gaetano Paone, Robert W. Emery, Victor A. Ferraris

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


Limiting blood transfusion in cardiac operations is a wellmeaning goal of perioperative care. Potential benefits include decreasing morbidity and limiting procedural costs. It is difficult to identify transfusion as the cause of adverse outcomes. The need for transfusion may identify a sicker patient population at greater risk for a worse outcome that may or may not be related to the transfusion. We reviewed the indications for and adverse effects of blood transfusion in patients undergoing cardiac procedures to provide a balanced approach tomanagement of blood resources in this population. We reviewed current literature, including systematic reviews and practice guidelines, to synthesize a practice management plan in patients having cardiac operations. Several prospective randomized studies and large population cohort studies compared a postoperative restrictive transfusion policy to a more liberal policy and found very little difference in outcomes but decreased costs with a restrictive policy. Evidence-based practice guidelines and implementation standards provide robust intervention plans that can limit harmful effects of transfusion and provide safe and effective procedure outcomes. A restrictive transfusion policy seems to be safe and effective but does not necessarily provide better outcome in most patient cohorts. The implications of these findings suggest that many discretionary transfusions could be avoided. A subset of high-risk patients could undoubtedly benefit from a more liberal transfusion policy, but the definition of high risk is ill defined.

Original languageEnglish
Pages (from-to)157-164
Number of pages8
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Issue number3
StatePublished - Aug 23 2016


  • Blood transfusion
  • Restrictive versus liberal transfusion strategy
  • Transfusion protocol

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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