Jehovah's Witnesses believe that the Bible (Genesis 9:4, Leviticus 17:10, and Acts 15:29) prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion. Specifically, their beliefs include:

• Blood represents life and is sacred to God. After it has been removed from a creature, the only use of blood that God has authorized is for the atonement of sins. When a Christian abstains from blood, they are in effect expressing faith that only the shed blood of Jesus Christ can truly redeem them and save their life.
• Blood must not be eaten or transfused, even in the case of a medical emergency.
• Blood leaving the body of a human or animal must be disposed of, except for autologous blood transfusions considered part of a current therapy.
• A baptized Witness who unrepentantly accepts a blood transfusion is deemed to have disassociated himself from the religion by abandoning its doctrines and is subsequently subject to organized shunning by other members.

Watch Tower Society publications teach that the Witnesses' refusal of transfusions of whole blood or its four primary components—red cells, white cells, platelets and plasma—is a non-negotiable religious stand and that those who respect life as a gift from God do not try to sustain life by taking in blood, even in an emergency. The following medical procedures are prohibited:

• Transfusion of allogeneic whole blood, or of its constituents of red cells, white cells, platelets or plasma.
• Transfusions of pre-operative autologous blood.

Members of the religion who voluntarily accept a transfusion are regarded as having disassociated themselves from the religion by abandoning its doctrines and are subsequently shunned by members of the organization.

For procedures where there is no specific doctrinal prohibition, individuals are to obtain details from medical personnel and then make a personal decision. The following procedures are left to the decision of individual members:

• Blood donation strictly for purpose of further fractionation of red cells, white cells, platelets or plasma for either allogeneic or autologous transfusion.
• Transfusions of autologous blood part of a "current therapy".
• Hemodilution, a modified technique in which equipment is arranged in a circuit that is constantly linked to the patient's circulatory system.
• Intraoperative blood salvage (autologous)
• Heart-Lung Machine
• Dialysis,
• Epidural Blood Patch
• Plasmapheresis,
• Labeling or Tagging of
• Platelet Gel
• Fractions from blood plasma:
  • oAlbumin
  • oGlobulins
  • oCryoprecipitate
  • oCryosupernatant
  • oClotting factor concentrates including Factor VII, VIII and IX
• Artificial blood substitutes

Dabigatran Etexilate (Pradaxa®) is an oral direct thrombin (factor IIa) inhibitor approved by the FDA to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation.Rivaroxaban, (Xarelto) is a factor Xa inhibitor, that has been approved by the FDA. Some of the pharmacokinetic properties of these drugs are compared in the following table.

Data from many phase III clinical trials of dabigatran and rivaroxaban indicated that the bleeding rate was approximately 3%. Unfortunately, if bleeding does occur, no specific antidote is available. Fresh frozen plasma will not be very effective in reversing the anticoagulant effect of these drugs because of its relatively low concentration of coagulation factor II (thrombin) and factor X. Most articles written on this topic have suggested that Prothrombin Complex Concentrate (PCC) would be useful in reversing the anticoagulant effect of these drugs because it contains large doses of coagulation factors II, VII, IX and X. However, a recent publication demonstrated that PCC corrected the anticoagulant effect of rivaroxaban but not dabigatran (Circulation 2011; 124:1573-79). The authors concluded that PCC is a viable treatment for reversing the anticoagulant effect of rivaroxaban but has no role in the reversal of dabigatran.

The only remaining option for treating the bleeding associated with dabigatran is recombinant activated factor VII (rFVIIa), which achieves hemostasis by directly activating thrombin on the surface of platelets. However, the use of rFVIIa has had inconsistent results with other direct thrombin inhibitors. Other options include activated charcoal to absorb recently ingested drug and dialysis. Clearly, more research is needed in this area.