Hospital-Wide TXA Policy May Reduce Transfusions in Major Noncardiac Surgery

A hospital policy of administering tranexamic acid (TXA) to patients undergoing major noncardiac surgery may reduce red blood cell transfusions without increasing the risk of venous thromboembolism, according to findings published June 10 in the New England Journal of Medicine.

The Tranexamic Acid to Reduce Transfusion in Major Noncardiac Surgery (TRACTION) trial enrolled more than 8,200 adults undergoing inpatient noncardiac procedures associated with a high risk of transfusion at 10 Canadian hospitals. Participating hospitals were assigned to implement a policy of intraoperative TXA administration or placebo at four-week intervals. Investigators evaluated whether routine TXA use in this setting could safely reduce transfusion requirements among patients undergoing major surgery.

RBC transfusions during hospitalization occurred in 7.4% of patients who received TXA, compared with 9.8% of patients who received placebo. VTE within 90 days occurred in 2.1% of patients in both groups. Rates of myocardial infarction, stroke, intensive care unit admission and 90-day survival were similar between groups.

Notably, more than 60% of surgeries included in the trial were performed for oncologic indications, a population with well-documented perioperative thrombotic risk. In this study, VTE incidence within 90 days was 2.4% in the TXA group and 2.6% in the placebo group. The authors said that these findings provide reassurance that TXA can be safely administered to patients with cancer undergoing major noncardiac surgery.

The findings are consistent with previous evidence supporting TXA use to reduce bleeding and transfusion requirements across several patient populations. By evaluating a hospital-wide policy in a broad range of major noncardiac procedures, including more than 5,000 oncologic surgeries, the TRACTION trial expands the evidence base supporting TXA use in populations that have historically prompted concern about thrombotic risk.