Preoperative anemia in cardiac surgery patients: how to achieve clinical optimization - a narrative review

Anemia is a common comorbidity in patients with cardiac disease, with iron deficiency accounting for approximately 80% of cases. Preoperative anemia has consistently been associated with increased morbidity and mortality in patients undergoing cardiac surgery. Moreover, this population carries a markedly elevated risk of red blood cell transfusion, which itself is linked to adverse clinical outcomes.

Patient blood management (PBM) represents a multidisciplinary, evidence-based strategy to address anemia, reduce unnecessary blood loss, and optimize transfusion practices. In this context, intravenous iron supplementation, with or without erythropoiesis-stimulating agents, has emerged as a promising intervention for the correction of preoperative anemia. Nevertheless, the establishment of local PBM programs and routine evaluation of anemic or iron-deficient patients should be promoted.

This narrative review provides a contemporary and clinically relevant synthesis of the evidence on preoperative anemia optimization in cardiac surgery. Particular emphasis is placed on key findings, existing knowledge gaps, and practical strategies for the detection, prevention, and treatment of preoperative anemia in this high-risk population. Further high-quality studies are required to define optimal therapeutic regimens and assess patient-centered outcomes.