Suh Sungmin, Kim Nayoung, Kim Sangho
Department of Anesthesia and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea.
J Clin Med. 2025 Sep 13;14(18):6456. doi: 10.3390/jcm14186456.
A 75-year-old Jehovah's Witness with recent ST-elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI) with stenting of the proximal LAD. She was later diagnosed with gallbladder cancer and required urgent surgery but firmly refused allogeneic blood transfusion. This posed a major challenge, as the surgery was expected to cause significant bleeding, and the patient had undergone coronary stenting within the previous three months, which is when the risk of stent thrombosis is highest if dual antiplatelet therapy (DAPT) is interrupted. After conducting a careful multidisciplinary discussion and obtaining informed consent, both aspirin and clopidogrel were discontinued five days preoperatively. Through comprehensive blood conservation strategies-including acute normovolemic hemodilution (ANH), intraoperative cell salvage, and robotic-assisted minimally invasive surgery-the patient successfully underwent extended cholecystectomy without transfusion. This case highlights the possibility of safe, completely transfusion-free major surgery in patients with recent PCI and high thrombotic risk when individualized perioperative planning is applied.
一名75岁的耶和华见证会信徒近期发生ST段抬高型心肌梗死（STEMI），接受了经皮冠状动脉介入治疗（PCI），在左前降支近端置入支架。她后来被诊断出患有胆囊癌，需要紧急手术，但坚决拒绝异体输血。这带来了重大挑战，因为手术预计会导致大量出血，且患者在过去三个月内接受了冠状动脉支架置入术，在此期间如果中断双联抗血小板治疗（DAPT），支架血栓形成的风险最高。经过仔细的多学科讨论并获得知情同意后，阿司匹林和氯吡格雷在术前五天停用。通过综合血液保护策略——包括急性等容血液稀释（ANH）、术中细胞回收和机器人辅助微创手术——患者成功接受了扩大胆囊切除术，未进行输血。该病例凸显了在近期接受PCI且血栓形成风险高的患者中，应用个体化围手术期规划进行安全、完全无输血的大型手术的可能性。
