Haemodynamics, fluids & transfusion
Hospital Policy of Tranexamic Acid to Reduce Transfusion in Major Noncardiac Surgery
Authors' conclusion
Among patients undergoing major noncardiac surgery, a hospital policy of tranexamic acid administration resulted in a lower incidence of red-cell transfusion than placebo administration, and tranexamic acid was noninferior to placebo with regard to diagnosis of venous thromboembolism.
Study context
- Population
- Patients undergoing major noncardiac surgery at high risk for red-cell transfusion, 10 Canadian hospitals
- Participants
- 8,273 patients · 10 Canadian hospitals
- Comparison
- Hospital-wide policy of intraoperative TXA vs placebo
- Tranexamic acidn = 4,156
- Placebon = 4,117reference
- Primary endpoint
- Coprimary: red-cell transfusion during index hospitalization (effectiveness); VTE within 90 days (safety, noninferiority)
Methodological detailsmulticentre, double-blind, cluster-randomised, cluster-crossover, placebo-controlled, noninferiority (safety outcome)
- Multicentre
- Double-blind
- Cluster-randomised
- Cluster-crossover
- Placebo-controlled
- Noninferiority (safety outcome)
Primary result
As reported in the abstract
Red-cell transfusion during hospitalization
Each group vs placeboRelative risk (95% CI)
Tranexamic acid
0.73(0.61–0.86)
Each group vs placeboAdjusted difference, percentage points (95% CI)
Tranexamic acid
−2.7(−4.2 to −1.4)
Safety
| Outcome | Tranexamic acid | Placebo | RR (95% CI) | |
|---|---|---|---|---|
| VTE within 90 days (coprimary safety outcome)Met the criterion for noninferiority | 2.1% | 2.1% | 0.96 (0.65–1.38) | |
| 0.512Relative risk (log scale) |
| Outcome | Adjusted difference (percentage points) (95% CI) | |
|---|---|---|
| VTE within 90 days (coprimary safety outcome)Met the criterion for noninferiority | −0.1 (−0.9 to 0.7) | |
| −1−0.500.51Difference, percentage points (linear scale) |
- VTE within 90 days (coprimary safety outcome): noninferiority margin: upper 95% CI boundary of RR 1.46
Original publication
Hospital Policy of Tranexamic Acid to Reduce Transfusion in Major Noncardiac Surgery. N Engl J Med. Published 10 June 2026. doi:10.
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