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

CARDIAC surgery with cardiopulmonary bypass (CPB) poses serious hemostatic challenges in Jehovah’s Witnesses, who refuse blood transfusions on religious grounds. Excessive bleeding ( 2 l) after cardiac surgery is encountered in 5–7% of Jehovah’s Witness patients, and necessitates reexploration in 3.6% of cases. 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 these patients. It has been used in hemophiliac and nonhemophiliac patients to treat bleeding diatheses in medical and surgical settings. We describe two cases of severe microvascular bleeding during and after mitral valve replacement in Jehovah’s Witness patients who were successfully treated with a single dose of rFVIIa.