Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery

Research output: Contribution to journalArticle

Jesse E. Harris, Sara Varnado, Elizabeth Herrera, Eric Salazar, Anthony C. Colavecchia

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: 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: 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: 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.

Original languageEnglish (US)
Pages (from-to)801-809
Number of pages9
JournalJournal of cardiac surgery
Volume35
Issue number4
DOIs
StatePublished - Feb 12 2020

PMID: 32048355

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Standard

Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery. / Harris, Jesse E.; Varnado, Sara; Herrera, Elizabeth; Salazar, Eric; Colavecchia, Anthony C.

In: Journal of cardiac surgery, Vol. 35, No. 4, 12.02.2020, p. 801-809.

Research output: Contribution to journalArticle

Harvard

Harris, JE, Varnado, S, Herrera, E, Salazar, E & Colavecchia, AC 2020, 'Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery' Journal of cardiac surgery, vol. 35, no. 4, pp. 801-809. https://doi.org/10.1111/jocs.14463

APA

Harris, J. E., Varnado, S., Herrera, E., Salazar, E., & Colavecchia, A. C. (2020). Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery. Journal of cardiac surgery, 35(4), 801-809. https://doi.org/10.1111/jocs.14463

Vancouver

Harris JE, Varnado S, Herrera E, Salazar E, Colavecchia AC. Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery. Journal of cardiac surgery. 2020 Feb 12;35(4):801-809. https://doi.org/10.1111/jocs.14463

Author

Harris, Jesse E. ; Varnado, Sara ; Herrera, Elizabeth ; Salazar, Eric ; Colavecchia, Anthony C. / Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery. In: Journal of cardiac surgery. 2020 ; Vol. 35, No. 4. pp. 801-809.

BibTeX

@article{68a215dd375f40888cb13ada40309521,
title = "Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery",
abstract = "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: 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: 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: 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.",
keywords = "Jehovah's Witness, factor concentrate, four-factor prothrombin complex concentrate, refusal of blood products, transfusion",
author = "Harris, {Jesse E.} and Sara Varnado and Elizabeth Herrera and Eric Salazar and Colavecchia, {Anthony C.}",
note = "{\circledC} 2020 Wiley Periodicals, Inc.",
year = "2020",
month = "2",
day = "12",
doi = "10.1111/jocs.14463",
language = "English (US)",
volume = "35",
pages = "801--809",
journal = "Journal of Cardiac Surgery",
issn = "0886-0440",
publisher = "Wiley",
number = "4",

}

RIS

TY - JOUR

T1 - Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery

AU - Harris, Jesse E.

AU - Varnado, Sara

AU - Herrera, Elizabeth

AU - Salazar, Eric

AU - Colavecchia, Anthony C.

N1 - © 2020 Wiley Periodicals, Inc.

PY - 2020/2/12

Y1 - 2020/2/12

N2 - 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: 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: 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: 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.

AB - 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: 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: 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: 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.

KW - Jehovah's Witness

KW - factor concentrate

KW - four-factor prothrombin complex concentrate

KW - refusal of blood products

KW - transfusion

UR - http://www.scopus.com/inward/record.url?scp=85079398413&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85079398413&partnerID=8YFLogxK

U2 - 10.1111/jocs.14463

DO - 10.1111/jocs.14463

M3 - Article

VL - 35

SP - 801

EP - 809

JO - Journal of Cardiac Surgery

T2 - Journal of Cardiac Surgery

JF - Journal of Cardiac Surgery

SN - 0886-0440

IS - 4

ER -

ID: 58817327