Overview
- A cluster‑crossover randomized trial of 8,273 high‑transfusion‑risk noncardiac operations found routine perioperative tranexamic acid lowered in‑hospital red‑cell transfusions from 9.8% to 7.4%, a 27% relative reduction.
- The trial met noninferiority for safety, showing identical 90‑day venous thromboembolism rates of 2.1% in the tranexamic acid and placebo groups.
- The results, published in the New England Journal of Medicine and reported on June 10, came from 10 Canadian hospitals that switched policy every four weeks and used linked clinical and administrative data to track outcomes.
- A large oncologic subgroup of about 5,000 patients saw no increase in 90‑day clotting (2.4% vs 2.6%), but the study excluded people with active thromboembolic disease, pregnant patients, and many vascular surgeries, leaving evidence gaps for those groups.
- Investigators and editorialists estimate major system gains if adopted widely, including large blood‑unit and cost savings, and they recommend behavior‑based implementation steps such as clinical decision support, training, opinion leadership, and performance feedback.