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Thread: Lessons learned from transfusion refusal

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    Lessons learned from transfusion refusal

    Lessons learned from transfusion refusal

    from News Medical --

    Lessons learned from transfusion refusal
    Published on July 10, 2012 at 5:15 PM ·

    By Sarah Guy

    MedWire News: Jehovah's Witness patients (Witnesses) who refuse blood transfusions during cardiac surgery are not at risk for surgical complications or long-term mortality compared with non-Witnesses who receive transfusions, report US researchers.

    Witnesses had fewer postoperative myocardial infarctions, fewer additional operations for bleeding, and a lower hazard for in-hospital death, says the team.

    The findings indicate that the severe blood-conserving management strategies used in Witness patients could benefit other patient groups, suggest Colleen Koch (Cleveland Clinic, Ohio) and co-investigators.

    "Witnesses hold beliefs that disallow blood product transfusion and therefore offer a natural experiment in severe blood conservation," they explain in the Archives of Internal Medicine, adding that blood conservation practices include preoperative use of erythropoietin, iron, and B-complex vitamins, and intraoperative use of antifibrinolytics.

    The study cohort included 322 Witness and 48,986 non-Witness cardiac surgery patients, the latter of whom received transfusions, who were followed up for a respective mean 9.6 and 8.6 years.

    The researchers report that the two groups showed similar rates of in-hospital mortality, at 3.1% of Witnesses and 4.5% of non-Witnesses, but Witnesses had significantly lower rates of additional operations for bleeding (3.7 vs 7.3%), myocardial infarction (0.3 vs 2.8%), and prolonged ventilation (6.0 vs 16.0%), than non-Witnesses.

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    Physicians Hatice Simsek MD's Avatar
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    Outcome of Patients Who Refuse Transfusion A... [Arch Intern Med. 2012] - PubMed - NCBI


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    Quote Originally Posted by Hatice Simsek MD View Post


    Outcome of Patients Who Refuse Transfusion A... [Arch Intern Med. 2012] - PubMed - NCBI

    Thank you for the reference!! Here is the actual paper's abstract - the above post is a newspaper article:


    Outcome of Patients Who Refuse Transfusion A... [Arch Intern Med. 2012] - PubMed - NCBI
    Pubmed.gov

    PubMed
    US National Library of Medicine National Institutes of Health


    Arch Intern Med. 2012 Jul 2:1-7. doi: 10.1001/archinternmed.2012.2449. [Epub ahead of print]
    Outcome of Patients Who Refuse Transfusion After Cardiac Surgery: A Natural Experiment With Severe Blood ConservationOutcome of Patients Who Refuse Transfusion.
    Pattakos G, Koch CG, Brizzio ME, Batizy LH, Sabik JF, Blackstone EH, Lauer MS.
    Abstract

    BACKGROUND Jehovah's Witness patients (Witnesses) who undergo cardiac surgery provide a unique natural experiment in severe blood conservation because anemia, transfusion, erythropoietin, and antifibrinolytics have attendant risks. Our objective was to compare morbidity and long-term survival of Witnesses undergoing cardiac surgery with a similarly matched group of patients who received transfusions. METHODS A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery at our center from January 1, 1983, to January 1, 2011. All Witnesses prospectively refused blood transfusions. Among non-Witnesses, 38 467 did not receive blood transfusions and 48 986 did. We used propensity methods to match patient groups and parametric multiphase hazard methods to assess long-term survival. Our main outcome measures were postoperative morbidity complications, in-hospital mortality, and long-term survival. RESULTS Witnesses had fewer acute complications and shorter length of stay than matched patients who received transfusions: myocardial infarction, 0.31% vs 2.8% (P = .01); additional operation for bleeding, 3.7% vs 7.1% (P = .03); prolonged ventilation, 6% vs 16% (P < .001); intensive care unit length of stay (15th, 50th, and 85th percentiles), 24, 25, and 72 vs 24, 48, and 162 hours (P < .001); and hospital length of stay (15th, 50th, and 85th percentiles), 5, 7, and 11 vs 6, 8, and 16 days (P < .001). Witnesses had better 1-year survival (95%; 95% CI, 93%-96%; vs 89%; 95% CI, 87%-90%; P = . 007) but similar 20-year survival (34%; 95% CI, 31%-38%; vs 32% 95% CI, 28%-35%; P = . 90). CONCLUSIONS Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.

    PMID:
    22751620
    [PubMed - as supplied by publisher]
    Last edited by rbrown1205; 07-12-2012 at 07:04 AM.

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