Patients undergoing cardiovascular surgery are at risk for excessive bleeding and associated complications. Factors that raise the risk of bleeding include defects in the hemostatic mechanism caused, in part, by cardiopulmonary bypass, the increasing complexity of the surgical procedures, surgical trauma, and exposure to antiplatelet or antithrombotic agents. Therapeutic interventions for perioperative bleeding often involve transfusion of allogeneic blood as well as re-exploration. Reducing the requirement for transfusions and decreasing operative times and re-exploration rates has important implications for patient outcomes, blood inventory, and overall healthcare costs. The availability of newer hemostatic pharmacologic agents as well as technical advances in blood conservation has the potential to markedly reduce and even eliminate the need for transfusion in cardiac surgery patients. However, to both optimize and integrate the use of these latest strategies requires the application of a multidisciplinary blood management program that is institution based, accepted by all healthcare providers, and involves well thought out transfusion algorithms to guide transfusion decisions. At this symposium you will hear about current concepts of hemostasis and their implications for the patient undergoing cardiac surgery, clinical trial data for pharmacologic hemostatic agents, and the role of these agents in reducing perioperative blood loss and transfusion requirements.