6/30/23, 2:20 AM TRICS III Pathway Feedback Search Clinical Topics Home Studies TRICS III TRICS III Disease Transfusion strategies in critical Trial question Is a restrictive RBC transfusion strategy noninferior to a liberal strategy in patients undergoing cardiac surgery? Study design Multi-center Open label RCT Population Characteristics of study participants 35.5% female N = 5243 64.5% male 5243 patients (1721 female, 3139 male) Inclusion criteria: adult patients undergoing cardiac surgery with cardiopulmonary bypass who had a moderate-to-high predicted risk of death, according to the European System for Cardiac Operative Risk Evaluation Key exclusion criteria: unable to receive blood products, declined blood products, involved in a preoperative autologous donation program, undergoing heart transplantation, having surgery solely for the insertion of a ventricular assist device, pregnant or lactating Interventions N=2430 restrictive blood transfusion therapy (transfuse if Hgb level was < 7.5 g/dL, starting from induction of anesthesia) https://web.pathway.md/studies/rectGGvRP0VoAhSKL 1/2 6/30/23, 2:20 AM TRICS III Pathway N=2430 liberal blood transfusion therapy (transfuse if Hgb level was < 9.5 g/dL in the operating room or ICU or was < 8.5 g/dL in the non-ICU ward) Primary outcome Death, myocardial infarction, stroke, or new-onset renal failure requiring dialysis at 28 days 12.5 % 12.5 11.4 9.4 % 6.3 % Difference not exceeding nonferiority margin 3.1 % 0.0 % Restrictive blood transfusion therapy Liberal blood transfusion therapy Difference not exceeding nonferiority margin in death, myocardial infarction, stroke, or new-onset renal failure requiring dialysis at 28 days (11.4% vs. 12.5%; OR 0.9, 95% CI 0.76 to 1.07) Secondary outcomes No significant difference in death (3% vs. 3.6%; OR 0.85, 95% CI 0.62 to 1.16) Conclusion In adult patients undergoing cardiac surgery with cardiopulmonary bypass who had a moderate-to- high predicted risk of death, according to the European System for Cardiac Operative Risk Evaluation, restrictive blood transfusion therapy was noninferior to liberal blood transfusion therapy with respect to death, myocardial infarction, stroke, or new-onset renal failure requiring dialysis at 28 days. Reference Mazer CD, Whitlock RP, Fergusson DA et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. N Engl J Med. 2017 Nov 30;377(22):2133-2144. Open reference URL https://web.pathway.md/studies/rectGGvRP0VoAhSKL 2/2