Landmark Trial Shows Tranexamic Acid Reduces Blood Transfusions in Major Surgeries Without Increasing Clot Risk
A large-scale clinical trial published in the *New England Journal of Medicine* has confirmed that tranexamic acid significantly reduces the need for blood transfusions in major surgeries without increasing the risk of dangerous blood clots, according to the study’s lead researchers. The findings, led by the University of Manitoba and The Ottawa Hospital, could reshape surgical practices globally.
What is Tranexamic Acid?
Tranexamic acid is an inexpensive medication that prevents excessive bleeding by stabilizing blood clots. It has been used in cardiac and orthopedic surgeries for over 30 years but has remained controversial for broader application in other major procedures, including cancer surgeries. The drug works by inhibiting the breakdown of fibrin, a protein essential for clot formation.
How Did the Trial Work?
The pan-Canadian TRACTION trial involved 8,273 major surgeries across 10 hospitals between February 2022 and March 2024. Researchers used a cluster-crossover design, randomly assigning hospitals to treat high-risk patients with either tranexamic acid or a placebo. Hospitals switched treatments every four weeks over two years. Data on transfusions and clotting events were analyzed from clinical and administrative health records.
Key Findings: Fewer Transfusions, No Increased Clot Risk
The study found that 7.4% of patients receiving tranexamic acid required blood transfusions, compared to 9.8% in the placebo group. For every 100 patients treated with the drug, 10 units of blood were saved. Notably, the risk of venous blood clots remained unchanged between the two groups, with a 2.1% incidence in both.
Why This Matters for Surgical Care
The results support expanding tranexamic acid use to all major surgeries where significant blood loss is anticipated. In Canada alone, universal adoption could reduce transfusions by 25% annually and cut blood unit usage by 10%, according to Dr. Daniel McIsaac, co-first author of the study. The drug’s low cost—under $10 per dose compared to over $700 for a single transfusion—also highlights its potential to reduce healthcare expenses.
Safety in Cancer Surgeries
The trial included 5,000 cancer patients, who are often excluded from such studies despite comprising a significant portion of surgical cases. Researchers found the drug safe and effective for this population, even though cancer patients are typically at higher risk for blood clots. “This removes a major barrier to its use in most major surgeries,” said Dr. Dean Fergusson, a co-senior author.
What’s Next for Tranexamic Acid?
The study’s authors emphasize the need for healthcare systems to adopt the drug as a standard practice. “This is transformative to patient care and could save millions of blood units annually,” said Dr. Brett Houston, co-first author. The findings align with global efforts to optimize resource use in surgery, particularly in low- and middle-income countries where blood supply is limited.
Publication Details
The study, titled *A hospital policy of tranexamic acid to reduce transfusion in major noncardiac surgery: The TRACTION trial*, was published in the *New England Journal of Medicine* on June 10, 2023. The research team included collaborators from the University of Manitoba, The Ottawa Hospital, and the Ottawa Methods Center.
Expert Commentary
Dr. Ryan Zarychanski, trial chair and hematologist, noted the potential for “profound savings to healthcare systems worldwide.” The findings add to a growing body of evidence supporting the drug’s role in reducing surgical complications, with implications for patient outcomes and healthcare economics.
