Hospital Policy of Tranexamic Acid Cuts Transfusions in High-Risk Surgery Without Raising Clot Risk

Overview

• TRACTION randomized 10 Canadian hospitals to alternating 4-week policies of tranexamic acid or placebo for adults undergoing higher-risk non-cardiac surgery, enrolling 8,273 patients.
• Transfusions occurred in 7.4% of TXA patients versus 9.8% with placebo, with fewer red-cell units given on average to those receiving TXA (0.34 vs 2.5).
• Thrombotic complications through 90 days were the same in both groups at 2.1%, with no excess in deep vein thrombosis, pulmonary embolism, myocardial infarction or stroke.
• Secondary outcomes showed no significant differences for ICU admission, hospital length of stay, in-hospital survival or 90-day overall survival.
• Investigators said the results support a low-cost, scalable hospital policy and plan clinician education, while noting generalizability limits from the Canada-only, EMR-capable hospital sample.