When Should You Transfuse a Patient Who Is Bleeding After Cardiopulmonary Bypass

A 68-year-old man with hypertension, hyperlipidemia, diabetes mellitus, and coronary artery disease (with a drug-eluting stent placed in the circumflex artery 2 years ago) presents with worsening angina over the past several months. Coronary catheterization reveals multi-vessel coronary artery disease with significant stenosis noted in the right coronary artery (RCA), left anterior descending artery (LAD), and circumflex artery (Cx). A coronary artery bypass graft (CABG) is scheduled, and you are the anesthesiologist. The patient tells you that he stopped taking clopidogrel 5 days ago, but took his aspirin and metoprolol that morning.