Thrombopoietin Receptor Agonist (Avatrombopag) Preoperative Administration to Ameliorate Sepsis-Related Thrombocytopenia in Jehovah's Witness Patients Undergoing Redo Cardiac Surgery for Acute Endocarditis: A Case Report.

Patients with infective endocarditis may present with severe thrombocytopenia, identifying higher-risk groups with worse clinical outcomes and mortality rates. Frequently, in the surgical setting, these patients may benefit from platelet transfusions; however, this is not always feasible. Jehovah's Witness (JW) patients refuse blood component transfusions on religious grounds, making the management of these patients extremely complex, to the point of deeming them inoperable. Thrombopoietin receptor agonists are now available for the treatment of thrombocytopenia in a variety of diseases. We report our experience with the off-label use of avatrombopag in the setting of sepsis-induced thrombocytopenia in two JW patients.