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. However, such a practice is uncommon because of the increased risk of hemodynamic instability. Off-pump CABG may avoid CPB-related coagulopathy caused by exposure of blood to artificial surfaces, mechanical trauma, alterations in temperature, and hemodilution. Some evidence suggests that off-pump CABG is associated with less bleeding and fewer blood transfusions.67,1069 1074 6. Specific Patient Subsets The term elderly in CABG patients is usually defined as 80 years of age. Compared with younger subjects, the elderly are more likely to have severe (left main or multi- vessel) CAD, LV systolic dysfunction, concomitant valvular disease, and previous sternotomy. In addition, they often have comorbid conditions, such as diabetes mellitus, hyper- tension, chronic obstructive pulmonary disease, PAD, and azotemia. As a result, the elderly have a higher perioperative risk of morbidity and mortality than do younger patients receiving CABG. 