A hospital policy of tranexamic acid to reduce transfusion in major non-cardiac surgery: The traction trial

作者：Brett L. Houston, Daniel I. McIsaac, Rodney H. Breau, Peter Greenstreet, Meghan Andrews, Sinziana Avramescu, Hema Bagry, Robert Balshaw, Jayesh Daya, Kaitlin Duncan, Christopher Harle, Eric Jacobsohn, Tina Kerelska, Marshall Pitz, Paul Komenda, Sarah McIsaac, Tim Ramsay, Tarit Saha, Alan Tinmouth, Angela Recio, Dayna Solvason, Daniel J. Szoke, Marshall Tenenbein, Robert Talarico, Dean Fergusson, Ryan Zarychanski · 发表于：Blood · 年份：2025 · DOI：10.1182/blood-2025-lba-5 · 被引用次数：2 · 研究领域：Blood transfusion and management、Trauma, Hemostasis, Coagulopathy, Resuscitation、Inflammatory Biomarkers in Disease Prognosis

Abstract BACKGROUND Whether a hospital policy of tranexamic acid administration for patients undergoing major noncardiac surgery safely reduces red blood cell (RBC) transfusion without increasing thrombotic risk is uncertain. METHODS We conducted a multicenter, registry-based, randomized, placebo-controlled, cluster-crossover trial enrolling patients undergoing noncardiac surgeries at high risk for RBC transfusion. Hospitals were randomized at 4-week intervals to a hospital-wide policy of intraoperative tranexamic acid or placebo. Co-primary effectiveness and safety outcomes were the proportion of patients transfused RBCs during hospital admission, and the proportion of patients diagnosed with venous thromboembolism within 90 days. The safety of the tranexamic policy compared to placebo was based on a non-inferiority margin where the upper boundary of the two-sided 95% confidence interval for the odds ratio of venous thromboembolism had to be below 1.47. Secondary outcomes included the number of RBC units transfused, in-hospital diagnoses of myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism, hospital length of stay, intensive care unit admission, hospital survival and overall survival to day 90. RESULTS The co-primary outcomes were evaluable for 8273 patients enrolled across 10 Canadian hospitals. Baseline characteristics were similar between the two groups. The most common surgical specialties included general surgery (n=2742; 33.1%), gynecology (n=15...