CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

July 2nd, 2012

Severe Blood Conservation Appears Safe in Cardiac Surgery for Jehovah’s Witnesses

Severe blood conservation in conjunction with cardiac surgery is not associated with long-term adverse consequences, according to a new study published in the Archives of Internal Medicine.

Investigators from the Cleveland Clinic and the NHLBI compared 322 patients who were Jehovah’s Witnesses with an equal number of matched controls. Due to their religious beliefs, Witnesses do not receive blood transfusions, and therefore “provide a unique natural experiment in severe blood conservation,” according to the authors.

Compared with patients who had transfusions, Witnesses had better short- and long-term outcomes. They had fewer complications in the hospital and better survival out to 15 years.

  • Perioperative MI: 0.31% for Witnesses vs. 2.8% for controls (p = 0.01)
  • Operation for bleeding: 3.7% vs. 7.1% (p = 0.03)
  • Prolonged ventilation: 6% vs. 16% (p < 0.001)
  • Hours in the ICU (15th, 50th, and 85th percentiles): 24 vs. 24, 25 vs. 48, and 72 vs. 162 (p < 0.001)
  • Survival at 5 years: 86% vs. 74%
  • Survival at 10 years: 69% vs. 53%
  • Survival at 15 years: 51% vs. 35%

The investigators conclude that although they “found differences in complications among Witnesses and control groups that received transfusions, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.”

In an accompanying commentary,  Victor Ferraris points out that “Witnesses who undergo cardiac surgery are likely a healthier subgroup of Witnesses because those who are believed by their surgeons to require blood transfusion to survive cardiac surgery presumably never go to the operating room.” Nevertheless, “the finding that the Witnesses who did not receive transfusions did at least as well as, if not better than, those who received a transfusion raises questions about whether more patients might benefit from surgical strategies that minimize transfusion of blood products.”

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