The American College of Physicians (ACP) identified patients who are at risk for cerebral or myocardial ischemic injury if they become volume depleted. These patients may benefit from a more aggressive blood transfusion policy and closer monitoring of blood losses.


Patients at risk for cerebral ischemia:

(1) hemodynamically significant valvular disease

(2) coronary artery disease

(3) congestive heart failure


Patients at risk for myocardial ischemia:

(1) history of transient ischemic attacks (TIA)

(2) history of previous thrombotic stroke



• Other patients with atherosclerotic disease might be at risk for ischemic complications if volume depleted, such as those with renal arterial stenosis or superior mesenteric artery disease.


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