2024 EACTS/EACTAIC Guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP

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  Central Illustration. Multidisciplinary patient blood management approach. CPB: cardiopulmonary bypass; DAPT: dual antiplatelet therapy; DDAVP: desmopressin; FFP: fresh-frozen plasma; PCC: prothrombin complex concentrate; POC: point-of-care; PRBCs: packed red blood cells.

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  Figure 1:. Management of antiplatelet therapy in patients having coronary artery bypass grafting surgery. aComplex and redo surgery, severe renal insufficiency, congenital and acquired bleeding and anaemia. bPlatelet function testing in urgent cases may be considered to optimize the timing and safety of surgery. cRecent stent implant, recent thromboembolic event and alarming angiographic results. ASA: acetylsalicylic acid; DAPT: dual antiplatelet therapy; GPIIb/IIIa: glycoprotein IIb/IIIa.

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  Figure 2:. Management of oral anticoagulation in patients with an indication for preoperative bridging and/or postoperative anticoagulation therapy. aPatients with mechanical prosthetic heart valve, atrial fibrillation with rheumatic valvular disease, acute thrombotic event within the prior 12 weeks, acquired or congenital pro-thrombotic defects and left ventricular apex thrombus. bDiscontinuation of LMWH depends on the type and dosing of the medication. cFor dabigatran, discontinuation should be prolonged to > 48 h if the estimated glomerular filtration rate (eGFR) is 50–80 ml/min/1.73 m2 and ≥96 h if eGFR is <50 ml/min/1.73 m2; it is contraindicated if the eGFR is <30 ml (min/1.73 m2 for other DOACs, discontinuation should be ≥ 72 h if the eGFR is 30–50 ml/min/1.73 m2 and > 96 h if the eGFR is 15–30 ml/min/1.73 m2. dBridging for VKA only with UFH/LMWH should be discontinued once the INR reaches the adequate target range, confirmed by 2 consecutive tests. DOAC: direct oral anticoagulant; INR: International normalized ratio; LMWH: low-molecular-weight heparin; UFH, unfractionated heparin; VKA: vitamin K antagonists.

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  Figure 3:. Key messages from the Multidisciplinary Patient Blood Management Guidelines for Adult Cardiac Surgery. CPB: cardiopulmonary bypass; DDAVP: desmopressin; DOAC: direct oral anticoagulant; EPO: erythropoietin; FFP: fresh-frozen plasma; PBM: patient blood management; PCC: prothrombin complex concentrate; POC: point-of-care; PRBCs: packed red blood cells; rFVIIa: recombinant factor VIIa; VKAs: vitamin-K antagonists.