Coagulopathy After Cardiopulmonary Bypass in Jehovah’s Witness Patients: Management of Two Cases Using Fractionated Components and Factor VIIa

  title={Coagulopathy After Cardiopulmonary Bypass in Jehovah’s Witness Patients: Management of Two Cases Using Fractionated Components and Factor VIIa},
  author={Roman M. Sniecinski and Edward P. Chen and Jerrold H. Levy and Fania Szlam and Kenichi A. Tanaka},
  journal={Anesthesia \& Analgesia},
BACKGROUND:Changes in the Jehovah's Witness (JW) blood refusal policy now give members the personal choice to accept certain processed fractions of blood, such as factor concentrates and cryoprecipitate. METHODS:Two JW patients undergoing complex aortic surgery who developed severe microvascular bleeding after prolonged use of cardiopulmonary bypass were treated with recombinant activated factor VII, cryoprecipitate, and antithrombin concentrate. RESULTS:Cardiopulmonary bypass-induced… 

Coagulopathy after cardiopulmonary bypass in Jehovah's Witness patients: management of and for the individual rather than the religious institution.

  • Lee Elder
  • Medicine
    Anesthesia and analgesia
  • 2007
Lee Elder Jehovah’s Witnesses read with interest the case study by Sniecinski et al. (1) concerning advances in treating patients who refuse certain products made from blood, and is grateful to medical science for advances facilitating safe perioperative care for patients with this preference.

Bleeding and management of coagulopathy.

Recombinant Activated Factor VII (rFVIIa) Treatment of Refractory Bleeding in Cardiac Surgical Patients

In patients undergoing cardiac surgery exhibiting refractory bleeding, rFVIIa at a mean dose of 93.7 ± 17 μg/kg improved significantly hemostasis and decreased additional administration of blood products, without any complication related to rF VIIa.

Thresholds for Perioperative Administration of Hemostatic Blood Components and Coagulation Factor Concentrates: An Unmet Medical Need.

Improvements in transfusion medicine include better donor testing, more stringent donation criteria, and improvements in both blood quality and blood component characteristics, all of which have contributed to the reduction of blood components-related complications.

Optimal care for patients who are Jehovah's Witnesses.

Harvey Jon Schiller, MD The article by Sniecinski et al. (1) on the treatment of two Jehovah’s Witnesses with coagulopathy presents a laudable approach toward improved communication with patients who

Repair of a large main pulmonary artery aneurysm in a 71-year-old Jehovah's Witness patient.

It is thought that a patient's status as a Jehovah's Witness need not preclude potentially life-saving cardiac operations, and the repair of a large pulmonary artery aneurysm in a 71-year-old woman who was a Jehovah’s Witness is reported.

Acute Intracardiac Thrombosis and Pulmonary Thromboembolism After Cardiopulmonary Bypass: A Systematic Review of Reported Cases

Case literature is provided to provide an update of case literature of a postbypass hypercoagulable state and further efforts to elucidate pathomechanisms and optimize anticoagulation during CPB and hemostatic interventions after CPB are warranted.

Reduced levels of fibrin (antithrombin I) and antithrombin III underlie coagulopathy following complex cardiac surgery.

Changes in plasma concentrations of fibrinogen and antithrombin after cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Data from 22 patients who underwent ascending aortic

The old and new: PCCs, VIIa, and long-lasting clotting factors for hemophilia and other bleeding disorders.

  • M. Ragni
  • Medicine, Biology
    Hematology. American Society of Hematology. Education Program
  • 2013
Understanding the comparative coagulation studies of established prohemostatic agents, the pharmacokinetics of new long-acting clotting factors, and their correlation with bleeding outcomes will provide opportunities to optimize the hemostatic management of both congenital and acquired he mostatic disorders.



Treatment of excessive bleeding in Jehovah's Witness patients after cardiac surgery with recombinant factor VIIa (NovoSeven).

Recombinant factor VIIa (rFVIIa, NovoSeven®; Novo Nordisk, Princeton, NJ), produced in baby hamster kidney cell lines and free of human protein, could be an alternative hemostatic agent and is generally acceptable to Jehovah's Witness patients.

Use of recombinant activated factor VII for bleeding following operations requiring cardiopulmonary bypass.

The successful use of rFVIIa is reported for the treatment of intractable postoperative bleeding following aortic aneurysm repair in two patients with Marfan syndrome, where hemostasis was rapidly achieved within minutes and gradually over several hours in the second patient.

Use of desmopressin and erythropoietin in an anaemic Jehovah’s Witness patient with severely impaired coagulation capacity undergoing stentless aortic valve replacement

Cardiac surgery in Jehovah’s Witness patients remains a challenge in the presence of concomitant congenital or acquired coagulation disorders and anaemia, and the beneficial properties of erythropoietin and desmopressin in Jehovah's Witness patients are discussed.

Multidisciplinary management of a Jehovah’s Witness patient for the removal of a renal cell carcinoma extending into the right atrium

Multiple blood conservation techniques were employed to manage this Jehovah’s Witness patient through complex cardiac surgery, which was previously denied to him at other institutions.

Activation of coagulation and fibrinolysis during cardiothoracic operations.

Dosing with recombinant factor viia based on current evidence.

  • U. Hedner
  • Medicine, Biology
    Seminars in hematology
  • 2004
Optimal doses may vary not only between hemophilia patients, but also between patients treated for other bleeding disorders, as interpatient variation in recovery rates, clearance rates, and the ability to generate thrombin on the activated platelet surface may influence the efficacy of rFVIIa.

Factors Associated with Excessive Postoperative Blood Loss and Hemostatic Transfusion Requirements: A Multivariate Analysis in Cardiac Surgical Patients

Analysis using 10 multiple logistic or linear regression models in 487 cardiac surgical patients included perioperative variables that may have an association with either transfusion of HBP and/or excessive postoperative chest tube drainage (CTD), and data support the use of reduced doses of porcine heparin during CPB.

A Phase III, Double-blind, Placebo-controlled, Multicenter Study on the Efficacy of Recombinant Human Antithrombin in Heparin-resistant Patients Scheduled to Undergo Cardiac Surgery Necessitating Cardiopulmonary Bypass

Treatment with 75 U/kg rhAT is effective in restoring heparin responsiveness and promoting therapeutic anticoagulation in the majority of hepar in-resistant patients, and may decrease the requirement forHeparin and fresh frozen plasma.

Recombinant factor VIIa enhances platelet adhesion and activation under flow conditions at normal and reduced platelet count

Increased platelet adhesion and aggregation by rFVIIa‐mediated thrombin formation may explain the therapeutic effects of rF VIIa in thrombocytopenic conditions and in patients with a normal platelet count by enhancement of primary hemostasis and enhancement of procoagulant surface leading to elevated fibrin formation.