This provocative retrospective study evaluated the outcome of patients who refuse blood transfusion after cardiac surgery. Using a propensity analysis to match Jehovah’s Witness (JW) and non-JW patients, the authors report that extreme blood conservation strategies do not appear to increase the risk of surgical complications or reduce long-term survival in patients who refuse blood transfusion. However, this observation has to take into account the special attention given to the management of JW patients undergoing surgery at high risk of bleeding. Thus, the author’s observations may have mainly resulted from an improvement in global care of JW patients rather than from the blood conservation approach alone.

– Philippe Van der Linden