Reducing operative blood loss is considered an important factor for improving patient outcomes and decreasing healthcare costs. A recently published narrative review provided an insight into current surgical, anesthetic and hemostatic intraoperative blood conservation strategies. This review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in surgical patients. According to this review, interventions can be initiated early in the preoperative phase by identifying patients at high risk of bleeding. Directly acting anticoagulants can be discontinued 48 hours before most of the surgeries, if renal function is normal and aspirin can be continued for most procedures. When anticipated blood loss is more than 500 ml, intraoperative cell salvage is advised and it can be continued post-surgery in certain circumstances. Tranexamic acid appears to be an effective drug with a good safety profile and can be administered when anticipated blood loss is high. However, optimal dose, timing and route of administration remain unclear. Furthermore, use of topical agents, tourniquet and drains may vary from patient-to-patient and is decided by the surgeon based on the condition of the patient. Anesthetic techniques include correct positioning of the patient, avoidance of hypothermia and regional anesthesia. Permissive hypotension may yield benefits in some patients. Hemostatic strategies that appear to be promising are use of pharmacological agents like desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic hemostatic as says. Therefore, in order to reduce perioperative blood loss, a multimodal and multidisciplinary approach should be followed.

Source: Br J Surg. 2020 Jan;107(2):e26-e38.