Tranexamic acid is an inexpensive, antifibrinolytic drug that has been used since the 1960’s. While several randomized clinical trials and systematic reviews have observed that tranexamic acid reduces blood loss and the incidence of RBC transfusions in cardiac and orthopedic surgeries, questions remain about the risk of thrombosis in surgical patients who receive tranexamic acid. To this end, a cluster-crossover trial, the TRACTION (Tranexamic Acid to Reduce Transfusion in Major Noncardiac Surgery) study, randomized 10 Canadian hospitals to give adult patients undergoing noncardiac surgery at risk for RBC transfusions either tranexamic acid or placebo (0.9% sodium chloride). During the study, 8,278 patients were enrolled (median age, 64 years; 47% men; 61% oncologic surgery patients), and patients received 1-g of tranexamic (n=4,156) or placebo (n=4,117) at the start of surgery followed by 1-g at the end. Fewer patients in the tranexamic arm received RBC transfusions during hospitalization compared to those in the placebo arm (7.4% vs. 9.8%; relative risk, 0.73; 95% C.I., 0.61 to 0.86). In addition, rates of venous thromboembolism within 90 days were the same—2.1% of patients in both arms, meeting the criteria for noninferiority. The TRACTION trial provides reassurance that tranexamic acid is safe and effective for noncardiac surgery patients including patients with cancer.
References:
- Houston BL, McIsaac DI, Breau RH, Kanji S, et al. Hospital Policy of Tranexamic Acid to Reduce Transfusion in Major Noncardiac Surgery. N Engl J Med. 2026 Jun 10. doi: 10.1056/NEJMoa2515820. Epub ahead of print. PMID: 42267805.
- Murphy MF, Roberts I. TRACTION for Greater Surgical Use of Tranexamic Acid. N Engl J Med. 2026 Jun 10. doi: 10.1056/NEJMe2603105. Epub ahead of print. PMID: 42267828.
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