Cardiac surgery is a distinctive surgical discipline that often necessitates the use of cardiopulmonary bypass (CPB) and full anticoagulation intraoperatively, along with varying levels of antithrombotic treatments both before and after the cardiac procedures. As a result, implementing precise anticoagulation strategies and meticulously monitoring reversal throughout the perioperative period to re-establish adequate coagulation effects at clinically relevant levels is a crucial endeavour in improving outcomes. These procedures are associated with an increased incidence of bleeding complications, frequently requiring allogeneic blood transfusions, which also are known to have associated short- and long-term risks.

The goal of the 2017 EACTS/EACTAIC guidelines on patient blood management (PBM) for adult cardiac surgery was to provide guidance for optimal patient preparation and for intra- and postoperative management (1), leading to recommended management of clinical conditions that affect bleeding, thrombosis and transfusion risks. Continuous research has since produced a plethora of advancements in the PBM field.

This document serves as an update to those guidelines, incorporating recent findings and technologies. Its goal is to summarize the clinical and scientific bases for the various aspects of PBM. Building on previous guidelines and statements that have offered valuable insights into modern PBM, these updated guidelines contain specific recommendations that reflect European practice.

A number of chapters were added in order to expand the scope of the application of the guidelines, such as haemostatic management in patients requiring temporary (tMCS) and durable mechanical circulatory support (dMCS). It is important to note that, due to the content specificity, PBM for paediatric cardiac surgery has been covered in a separate document that has been developed in parallel with this one. When covering broad topics, such as surgical and CPB techniques, the recommendations in these guidelines are focused on PBM aspects, trying not to compromise the general procedural approach.