Streptokinase, urokinase, and tissue- type plasminogen activator should be stopped before CABG; in these individuals, the timing of CABG depends on the pharmacodynamic half-life of the agent involved.1110 The use of unfractionated heparin has not been associated with increased perioperative blood loss; it can be continued until a few hours before CABG. Low-molecular-weight heparin can be administered safely 12 hours preoperatively and does not result in excessive perioperative blood loss.1064 1068 Lysine analogues, such as epsilon-aminocaproic acid and tranexamic acid, inhibit fibrinolysis by binding to the plasminogen mole- cule. Several trials have shown that both epsilon-aminocaproic acid and tranexamic acid reduce blood loss and blood transfu- sions during cardiac surgery, but they do not reduce the rate of reexploration for bleeding.1044 1051 Both drugs appear to be safe and do not increase the risk of death.1111 Erythropoietin is a glycoprotein hormone that stimulates red blood cell production. Recombinant human erythropoietin is used in combination with iron supplementation to treat anemic patients (hemoglobin levels 13 g/dL) with renal failure and those undergoing chemotherapy. The use of erythropoietin in cardiac surgery has been studied in 12 RCTs and has been shown to be associated with significant risk reduction in allogeneic blood transfusion after cardiac sur- gery.1112 1122 However, the data from the RCTs are heteroge- neous, with different doses of erythropoietin administered for 1 to 3 weeks preoperatively; as a result, further studies are needed to define more precisely the patient subgroups who may benefit from this therapy.1123 In patients who refuse blood transfusions during cardiac surgery, a short-term course of preoperative erythropoietin, to produce a high hematocrit preoperatively, may be administered.1124,1125 Alternatively, autologous blood donation may be used, which consists of extracting 1 to 3 units during the 30 days preoperatively and then reinfusing it during or postoperatively. 