Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery.
Aged
Blood Coagulation Factors
/ administration & dosage
Blood Loss, Surgical
/ prevention & control
Blood Transfusion
/ psychology
Cardiac Surgical Procedures
/ methods
Female
Hemoglobins
/ metabolism
Humans
Intraoperative Care
Male
Middle Aged
Outcome Assessment, Health Care
Postoperative Period
Religion
Retrospective Studies
Treatment Outcome
Treatment Refusal
Jehovah's Witness
factor concentrate
four-factor prothrombin complex concentrate
refusal of blood products
transfusion
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
pubmed:
13
2
2020
medline:
29
9
2020
entrez:
13
2
2020
Statut:
ppublish
Résumé
Patients who refuse allogeneic blood transfusions (alloBT) on the basis of religious doctrine, such as Jehovah's Witnesses (JWs), can pose a challenge when undergoing surgical procedures. During cardiac surgery, special considerations regarding surgical techniques and blood loss minimization strategies can lead to improved outcomes. Limited literature exists to guide the use of four-factor prothrombin complex concentrate (4PCC) in this patient population undergoing cardiac surgery. This retrospective, single-center study evaluated the impact of 4PCC on hemoglobin (Hgb) change from baseline to postoperative nadir within a 7-day period among patients who refused alloBT during cardiac surgery. This study identified patients who refused alloBT from January 2011 to June 2017. Multivariable linear regression was used to control for confounding variables to evaluate the effectiveness of 4PCC. During the study timeframe, 79 patients met inclusion criteria, all of whom identified as JWs, and underwent cardiac surgery. Of these, 19 received intraoperative 4PCC. Multivariable linear regression found no difference in Hgb change in patients who received 4PCC vs those who did not. No significant differences were found in mortality, thromboembolic complications, or in-hospital postoperative events. In JWs undergoing cardiac surgery who refuse alloBT, intraoperative use of 4PCC was not associated with a difference in Hgb change within 7 days postoperatively when adjusting for confounding variables. In the event of excessive blood loss, the utilization of 4PCC may provide a viable option in JW patients who undergo cardiac surgery where few options exist to mitigate blood loss.
Sections du résumé
BACKGROUND
BACKGROUND
Patients who refuse allogeneic blood transfusions (alloBT) on the basis of religious doctrine, such as Jehovah's Witnesses (JWs), can pose a challenge when undergoing surgical procedures. During cardiac surgery, special considerations regarding surgical techniques and blood loss minimization strategies can lead to improved outcomes. Limited literature exists to guide the use of four-factor prothrombin complex concentrate (4PCC) in this patient population undergoing cardiac surgery.
STUDY DESIGN AND METHODS
METHODS
This retrospective, single-center study evaluated the impact of 4PCC on hemoglobin (Hgb) change from baseline to postoperative nadir within a 7-day period among patients who refused alloBT during cardiac surgery. This study identified patients who refused alloBT from January 2011 to June 2017. Multivariable linear regression was used to control for confounding variables to evaluate the effectiveness of 4PCC.
RESULTS
RESULTS
During the study timeframe, 79 patients met inclusion criteria, all of whom identified as JWs, and underwent cardiac surgery. Of these, 19 received intraoperative 4PCC. Multivariable linear regression found no difference in Hgb change in patients who received 4PCC vs those who did not. No significant differences were found in mortality, thromboembolic complications, or in-hospital postoperative events.
CONCLUSIONS
CONCLUSIONS
In JWs undergoing cardiac surgery who refuse alloBT, intraoperative use of 4PCC was not associated with a difference in Hgb change within 7 days postoperatively when adjusting for confounding variables. In the event of excessive blood loss, the utilization of 4PCC may provide a viable option in JW patients who undergo cardiac surgery where few options exist to mitigate blood loss.
Substances chimiques
Blood Coagulation Factors
0
Hemoglobins
0
prothrombin complex concentrates
37224-63-8
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
801-809Subventions
Organisme : Houston Methodist Hospital
Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Anon. The Watchtower. 1945; 200-201.
Watchtower Bible and Tract Society. Statement to the media; 2000.
Pattakos G, Koch CG, Brizzio ME, et al. Outcome of patients who refuse transfusion after cardiac surgery: a natural experiment with severe blood conservation. Arch Intern Med. 2012;172:1154.
Moraca RJ, Wanamaker KM, Bailey SH, et al. Strategies and outcomes of cardiac surgery in Jehovah's Witnesses. J Card Surg. 2011;26:135-143.
Vasques F, Kinnunen EM, Pol M, Mariscalco G, Onorati F, Biancari F. Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies. Transfusion. 2016;58(8):2146-2153.
Bhaskar B, Jack RK, Mullany D, Fraser J. Comparison of outcome in Jehovah's Witness patients in cardiac surgery: an Australian experience. Heart Lung Circ. 2010;19:655-659.
McCartney S, Guinn N, Roberson R, Broomer B, White W, Hill S. Jehovah's Witnesses and cardiac surgery: a single institution's experience. Transfusion. 2014;54:2745-2752.
Marinakis S, Van der Linden P, Tortora R, Massaut J, Pierrakos C, Wauthy P. Outcomes from cardiac surgery in Jehovah's witness patients: experience over twenty-one years. J Cardiothorac Surg. 2016;11(1):67.
Marshall L, Krampl C, Vrtik M, et al. Short term outcomes after cardiac surgery in a Jehovah's Witness population: an institutional experience. Heart Lung Circ. 2012;21(2):101-104.
Vaislic CD, Dalibon N, Ponzio O, et al. Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year experience. J Cardiothorac Surg. 2012;7:95.
Tanaka A, Ota T, Uriel N, et al. Cardiovascular surgery in Jehovah's Witness patients: The role of preoperative optimization. J Thorac Cardiovasc Surg. 2015;150(4):976-83.e1-3.
Rogers DM, Crookston KP. The approach to the patient who refuses blood transfusion. Transfusion. 2006;46:1471-1477.
Shahian DM, Jacobs JP, Badhwar V, et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: part 1-Background, design considerations, and model development. Ann Thorac Surg. 2018;105(5):1411-1418.
O'Brien SM, Feng L, He X, et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: Part 2-Statistical methods and results. Ann Thorac Surg. 2018;105(5):1419-1428.
Kcentra® [package insert]. Marburg: CSL Behring LLC; 2014.
Cappabianca G, Mariscalco G, Biancari F, et al. Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery. Crit Care. 2016;20(5):1-9.
Amekian V, Camous J, Fattal S, Rézaiguia-Delclaux S, Nottin R, Stéphan F. Use of prothrombin complex concentrate for excessive bleeding after cardiac surgery. Interact Cardiovasc Thorac Surg. 2012;1:382-389.
Silvetti S, Crivellari M, Castiglioni A, et al. CASE 12-2016 ascending aorta dissection in Jehovah's Witness patient on warfarin. J Cardiothorac Vasc Anesth. 2016;30:1709-1715.
Robblee JA, Wilkes PRH, Dickie SJ, Rubens FD, Bormanis J. Bleeding in a Jehovah's Witness patient undergoing a redo aortic valve replacement controlled with cryoprecipitate and a prothrombin complex concentrate. Can J Anaesth. 2012;59:299-303.
Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;31:2301-2311.
Wademan BH, Galvin SD. Desmopressin for reducing postoperative blood loss and transfusion requirements following cardiac surgery in adults. Interact Cardiovasc Thorac Surg. 2014;18(3):360-370.
Paparella D, Brister SJ, Buchanan MR. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med. 2004;30(10):1873-1881.
Levi M, Peters M, Buller HR. Efficacy and safety of recombinant factor VIIa for the treatment of severe bleeding: a systematic review. Crit Care Med. 2005;33:883-890.
Habib AM, Mousa AY, Al-Halees Z. Recombinant activated factor VII for uncontrolled bleeding postcardiac surgery. J Saudi Heart Assoc. 2016 Oct;28(4):222-231.
Simpson E, Lin Y, Stanworth S, Birchall J, Doree C, Hyde C. Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia. Cochrane Database Syst Rev. 2012:CD005011.
Shen S, Zhang J, Wang W, Zheng J, Xie Y. Impact of intra-operative cell salvage on blood coagulation in high-bleeding risk patients undergoing cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial. J Transl Med. 2016;14:228.
Belfort M, Kofford S, Varner M. Massive obstetric hemorrhage in a Jehovah's Witness: Intraoperative strategies and high-dose erythropoietin use. Am J Perinatol. 2011;28(3):207-210.
Price S, Pepper JR, Jaggar SI. Recombinant human erythropoietin use in a critically ill Jehovah's Witness after cardiac surgery. Anesth Analg. 2005;101(2):325-327, table of contents.
Procrit® [package insert]. Thousand Oaks, CA: Amgen Inc; 2008.