It is recommended that surgery be delayed after the administration of streptokinase, urokinase, and tissue-type plasminogen activators until hemostatic capacity is restored, if possible. The timing of rec- ommended delay should be guided by the pharma- codynamic half-life of the involved agent. (Level of Evidence: C) 5. Tirofiban or eptifibatide should be discontinued at least 2 to 4 hours before CABG and abciximab at least 12 hours before CABG.526 528,1049,1050,1064 1068 (Level of Evidence: B) Class IIa 1. It is reasonable to consider off-pump CABG to reduce perioperative bleeding and allogeneic blood transfusion.67,1069 1074 (Level of Evidence: A) See Online Data Supplements 40 to 42 for additional data on bleeding/transfusion. Approximately 10% of allogeneic blood transfusions in the United States are given to subjects undergoing cardiac sur- gery.1075 Allogeneic transfusion carries the risks of transfu- sion reactions, airborne infections, and increased hospital costs. In patients undergoing isolated CABG, transfusions are associated with reduced long-term survival and worse quality About 10% to 20% of the cardiac patients who are transfused receive roughly 80% of the transfusions that are administered.1075,1078 These high-risk patients often can be identified preoperatively to facilitate measures directed at blood conservation. 