Jul 10 2012
By Piriya Mahendra
Jehovah's Witnesses do not have a significantly increased risk for complications or long-term mortality after cardiac surgery, researchers say.
This means that the blood conservation strategies they engage in as an alternative to blood transfusion before cardiac surgery do not place them at heightened risk for reduced long-term survival, contrary to evidence from previous studies.
The findings, reported in the Archives of Internal Medicine, showed that Jehovah's Witnesses had a significantly lower incidence of myocardial infarction (0.31 vs 2.80%), additional operation for bleeding (3.7 vs 7.1%), and prolonged ventilation (6 vs 16%) than non-Witnesses.
Jehovah's Witnesses were also less likely to stay in the intensive care unit and in the hospital for long periods compared with non-Witnesses, at median durations of 25 hours versus 48 hours; and 7 days versus 8 days, respectively (p<0.001 for both).
In addition, Jehovah's Witnesses had a higher 1-year survival rate compared to non-Witnesses, at 95% versus 89%, but statistically similar 20-year survival rates.
Jehovah's Witnesses shun blood transfusion and instead strongly believe in the use of blood conservation practices before surgery to avoid anemia, including preoperative use of erythropoietin and iron and B complex vitamins, intraoperative use of antifibrinolytics, and postoperative liberal use of additional operation for bleeding.
These practices have been associated with morbidity in the past, and their effect on long-term survival is unknown.
However, the results of the current study "cast doubt on observational data, suggesting that perioperative blood transfusion decreases long-term survival," remarks editorialist Victor Ferraris (University of Kentucky, Lexington, USA) in a related commentary.
"The findings of this analysis… add to the increasing data that suggest that more conservative use of blood transfusions would be in our patients' interest, in both Witnesses and non-Witnesses."
The analysis included 322 Jehovah's Witnesses and 87,453 non-Witnesses who underwent cardiac surgery between 1983 and 2011. All Jehovah's Witnesses refused blood transfusions. Of the non-Witnesses, 38,467 did not receive blood transfusions and 48,986 did.
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