Jehovah’s Witnesses, who do not accept transfusion of blood products, appear to fare at least as well as patients who do receive transfusions after undergoing similar cardiac surgery, according to a report published online July 2 in the Archives of Internal Medicine.
In a single-center study of more than 49,000 consecutive cardiac operations, Jehovah’s Witnesses who refused transfusions had fewer in-hospital complications, better early survival, and similar long-term survival as did transfusion recipients, said Dr. Gregory Pattakos of the Heart and Vascular Institute, Cleveland Clinic, and his associates.
The findings suggest that avoiding transfusions may be beneficial for other patients undergoing cardiac surgery, they noted.
Typically, physicians use a number of blood-conservation practices before, during, and after surgery in patients who are Witnesses, to avert the need for transfusions. These include preoperative erythropoietin, iron, and B-complex vitamins; hemoconcentration; minimal use of crystalloids; intraoperative antifibrinolytics; use of cell-saver and smaller cardiopulmonary bypass circuits; and postoperative tolerance of low hematocrit levels.
Dr. Pattakos and his colleagues assessed outcomes in 48,986 cardiac surgery patients who received red blood cell transfusions perioperatively in 1983-2011 and 322 Witnesses who did not. Since the study subjects could not be randomized for receiving transfusions, the investigators adjusted for baseline differences between the two study groups by using propensity matching.
Median follow-up was approximately 7-9 years.
Compared with transfusion recipients, Witnesses had similar rates of in-hospital mortality, stroke, atrial fibrillation, and renal failure. Witnesses had lower rates of postoperative MI, prolonged ventilation, and reoperation for bleeding complications, and they had shorter ICU stays and shorter hospitalizations than transfusion recipients, the researchers said (Arch. Intern. Med. 2012 [doi:10.1001/archinternmed.2012.2449]).
Witnesses’ survival rates were 86% at 5 years, 69% at 10 years, 51% at 15 years, and 34% at 20 years after surgery. These were not significantly different from the transfusion recipients\' survival rates of 74%, 53%, 35%, and 23%, respectively.
Some of the blood-conservation strategies adopted for Witnesses may benefit other patients as well. Unfortunately, the design of this study did not allow for determination of which strategies contributed most to the beneficial outcomes, they said.
One limitation of this study is that Jehovah’s Witnesses who presented to the Cleveland Clinic and were accepted there by surgeons "likely represent a select group who might have been expected by their physicians to have better outcomes," Dr. Pattakos and his associates added.