6/30/23, 2:20 AM TRICS III 6 month follow up Pathway Feedback Search Clinical Topics Home Studies TRICS III 6 month follow up TRICS III 6 month follow up Disease Transfusion strategies in critical Trial question Is the restrictive strategy for red-cell transfusion noninferior to a liberal strategy among patients undergoing cardiac surgery who were at moderate-to-high risk for death? 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 were at moderate-to-high predicted risk for death Key exclusion criteria: unable to receive or refusal of blood products, involvement in a preoperative autologous pre-donation program, undergoing heart transplant or surgery solely for insertion of a ventricular assist device Interventions N=2430 a restrictive transfusion strategy (red cell transfusion if the Hgb concentration < 7.5 g/dL intraoperatively or postoperatively) https://web.pathway.md/studies/recdiG8d9bwdfAE0S 1/2 6/30/23, 2:20 AM TRICS III 6 month follow up Pathway N=2430 a liberal transfusion strategy (transfusion if the Hgb concentration < 9.5 g/dL in the ICU or < 8.5 g/dL in the non-ICU ward) Primary outcome Rate of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis occurring within 6 months after the initial surgery 17.4 % 17.4 17.1 13.0 % 8.7 % Difference not exceeding nonferiority margin 4.3 % 0.0 % A restrictive transfusion strategy A liberal transfusion strategy Difference not exceeding nonferiority margin in the rate of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis occurring within 6 months after the initial surgery (17.4% vs. 17.1%; OR 1.02, 95% CI 0.87 to 1.18) Secondary outcomes No significant difference in death at 6 months (6.2% vs. 6.4%; OR 0.95, 95% CI 0.75 to 1.21) No significant difference in the rate of death from any cause, myocardial infarction, stroke, or new- onset renal failure with dialysis, emergency department visit, hospital readmission, or coronary revascularization occurring within 6 months after the initial surgery (43.8% vs. 42.8%; OR 1.04, 95% CI 0.93 to 1.17) No significant difference in myocardial infarction at 6 months (7.3% vs. 7.3%; OR 0.99, 99% CI 0.79 to 1.24) Safety outcomes No significant differences in stroke, new-onset renal failure with dialysis, coronary revascularization. Conclusion In adult patients undergoing cardiac surgery with cardiopulmonary bypass who were at moderate- to-high predicted risk for death, a restrictive transfusion strategy was noninferior to a liberal transfusion strategy with respect to the rate of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis occurring within 6 months after the initial surgery. Reference C David Mazer, Richard P Whitlock, Dean A Fergusson et al. Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery. N Engl J Med. 2018 Sep 27;379(13):1224-1233. Open reference URL https://web.pathway.md/studies/recdiG8d9bwdfAE0S 2/2