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040			_aBMG
041			_aeng
100			_aHouston, Brett L. _eAutor _953871
245			_aHospital policy of tranexamic acid to reduce transfusion in major noncardiac surgery
300			_apáginas: 2419-2428
520			_aBackground: Whether a hospital policy of tranexamic acid administration for patients undergoing major noncardiac surgery safely reduces the need for red-cell transfusion is uncertain. Methods: We conducted a multicenter, double-blind, cluster-randomized, placebo-controlled trial involving patients undergoing noncardiac surgery who were at high risk for red-cell transfusion. Hospitals were randomly assigned at 4-week intervals to a hospital-wide policy of intraoperative tranexamic acid or placebo. The coprimary effectiveness and safety outcomes were transfusion of red cells during the index hospitalization and diagnosis of venous thromboembolism within 90 days, respectively. The safety outcome was assessed for noninferiority, with a prespecified noninferiority margin defined as an upper boundary of 1.46 for the 95% confidence interval of the relative risk. Analyses used mixed-effects models that accounted for the cluster-crossover design. Results: A total of 8273 patients enrolled across 10 Canadian hospitals could be evaluated for the coprimary outcomes. Oncologic surgery accounted for 60.5% of the surgical procedures (5002 of 8273). The percentage of patients who received a red-cell transfusion during hospitalization was 7.4% (306 of 4156) in the tranexamic acid group and 9.8% (403 of 4117) in the placebo group (relative risk, 0.73; 95% confidence interval [CI], 0.61 to 0.86; adjusted difference, −2.7 percentage points; 95% CI, −4.2 to −1.4). Venous thromboembolism within 90 days occurred in 2.1% of patients (86 of 4128) in the tranexamic acid group and 2.1% of patients (85 of 4052) in the placebo group (relative risk, 0.96; 95% CI, 0.65 to 1.38; adjusted difference, −0.1 percentage points; 95% CI, −0.9 to 0.7), which met the criterion for noninferiority. Conclusions: Among patients undergoing major noncardiac surgery, a hospital policy of tranexamic acid administration resulted in a lower incidence of red-cell transfusion than placebo administration, and tranexamic acid was noninferior to placebo with regard to diagnosis of venous thromboembolism.
650			_aANTICOAGULACIÓN _953834
650			_aTROMBOEMBOLISMO _932218
650			_aCARDIOLOGÍA _911301
650			_aNEUMOLOGÍA _925628
700			_aMcIsaac, Daniel I. _953872
700			_aBreau, Rodney H. _953873
700			_aKanji, Salmaan _953874
700			_aGreenstreet, Peter _953875
700			_aAndrews, Meghan _953876
773	0		_022717 _922639 _dMassachusetts NEJM Group _oNEJM006 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-07-31 _zSQB
999			_c22761 _d22761