University of Oulu

Andrew Klein, Seema Agarwal, Bernard Cholley, Jens Fassl, Michael Griffin, Timo Kaakinen, Patrick Paulus, Steffen Rex, Martin Siegemund, Annewil van Saet, A review of European guidelines for patient blood management with a particular emphasis on antifibrinolytic drug administration for cardiac surgery, Journal of Clinical Anesthesia, Volume 78, 2022, 110654, ISSN 0952-8180,

A review of European guidelines for patient blood management with a particular emphasis on antifibrinolytic drug administration for cardiac surgery

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Author: Klein, Andrew1; Agarwal, Seema2; Cholley, Bernard3,4;
Organizations: 1Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK
2Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
3AP-HP Hôpital Européen Georges Pompidou, 20 rue Leblanc F-75015, Paris, France
4Université de PARIS, INSERM UMR-S 1140, Innovations Thérapeutiques en Hémostase, Faculté de Pharmacie, 4 avenue de l'observatoire, 75006 Paris, France
5Herzzentrum Dresden GmbH Universitätsklinik an der Technischen Universität Dresden, Fetscherstraße 76, 01307 Dresden, Germany
6Mater University Hospital and Mater Private Hospital, Dublin, Ireland
7Associate Professor of Anaesthesiology & Perioperative Medicine, UCD Medical School, Dublin, Irish Medical Council, Ireland
8Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
9Kepler University Hospital GmbH, Med Campus III, Department of Anesthesiology and Intensive Care Medicine, Krankenhausstrasse 9, 4020 Linz, Austria
10Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
11Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
12Intensive Care Unit Department of Clinical Research, University Basel, Switzerland
13Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.6 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2022-05-20


The concept of patient blood management (PBM) was introduced by the World Health Organization in 2011 and is defined as a “patient-focused, evidence-based and systematic approach for optimizing the management of patients and transfusion of blood products to ensure high quality and effective patient care”. Patient blood management is a multimodal approach based on three pillars: optimization of blood mass, minimization of blood loss and optimization of patient tolerance to anaemia.

Antifibrinolytics play a major role in cardiac surgery, where the risk of perioperative bleeding is high and affects a majority of patients, by effectively reducing bleeding, transfusions, re-operations, as well as their associated morbidity and mortality. They represent an essential part of the pharmacological arsenal of patient blood management.

However, despite the trend towards high-level PBM practices, currently very few European countries have national PBM guidelines and these guidelines, taken as a whole, are heterogeneous in form and content. In particular, the use of antifibrinolytics in cardiac surgery is often not discussed in detail beyond general prophylactic use and any recommendations lack detail including choice of drug, dosing, and mode of administration.

Thus, the implementation of PBM programs in Europe is still challenging.

In 2021, the WHO published a new document highlighting the urgent need to close the gap in PBM awareness and implementation and announced their upcoming initiative to develop specific PBM implementation guidelines.

This review aims first, to summarize the role played by fibrinolysis in haemostatic disorders; second, to give an overview of the current available guidelines in Europe detailing PBM implementation in cardiac surgery; and third, to analyse the place and use of antifibrinolytics in these guidelines.

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Series: Journal of clinical anesthesia
ISSN: 0952-8180
ISSN-E: 1873-4529
ISSN-L: 0952-8180
Volume: 78
Article number: 110654
DOI: 10.1016/j.jclinane.2022.110654
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by Nordic Pharma, for the institutional support, and Public Health Expertise for the medical writing support.
Copyright information: © 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (