In an attempt to investigate the effect of current extreme blood management strategies on outcome of patients undergoing cardiac surgery, Pattakos et al1 used, what they called, the “natural experiment” of Jehovah's Witnesses, who refuse blood transfusions owing to religious beliefs.1 They performed a statistically elaborate analysis of operative and long-term outcomes in Witnesses compared with propensity-matched patients who received transfusions. They concluded that extreme blood management strategies do not appear to place patients at heightened risk for operative mortality and morbidity nor reduce their long-term survival.1 As a matter of fact, their analysis demonstrated that Witnesses had a relatively improved overall outcome, ie, a lower operative morbidity and, in long-term follow-up, a lower risk of death in the early hazard phase. Hence, this report corroborates other observational studies indicating that transfusions are associated with negative outcomes following cardiac operations.2,3
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