Harris Jesse E, Varnado Sara, Herrera Elizabeth, Salazar Eric, Colavecchia Anthony C
Department of Pharmacy, Houston Methodist Hospital, Houston, Texas.
Department of Anesthesiology, Houston Methodist Hospital, Houston, Texas.
J Card Surg. 2020 Apr;35(4):801-809. doi: 10.1111/jocs.14463. Epub 2020 Feb 12.
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.
基于宗教教义拒绝接受异体输血（alloBT）的患者，如耶和华见证人（JWs），在接受外科手术时可能会带来挑战。在心脏手术中，关于手术技术和最小化失血策略的特殊考虑可改善手术结果。目前关于在接受心脏手术的此类患者中使用四因子凝血酶原复合物浓缩剂（4PCC）的文献有限。
这项回顾性单中心研究评估了4PCC对心脏手术期间拒绝alloBT的患者在7天内血红蛋白（Hgb）从基线到术后最低点变化的影响。本研究确定了2011年1月至2017年6月期间拒绝alloBT的患者。采用多变量线性回归来控制混杂变量，以评估4PCC的有效性。
在研究期间，79名患者符合纳入标准，所有患者均为JWs，并接受了心脏手术。其中，19名患者术中接受了4PCC。多变量线性回归发现，接受4PCC的患者与未接受4PCC的患者在Hgb变化方面没有差异。在死亡率、血栓栓塞并发症或术后住院事件方面未发现显著差异。
在接受心脏手术且拒绝alloBT的JWs患者中，调整混杂变量后，术中使用4PCC与术后7天内Hgb变化无差异。在失血过多的情况下，对于接受心脏手术且减少失血选择有限的JW患者，使用4PCC可能是一种可行的选择。
