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Tranexamic acid, an antifibrinolytic agent, is used routinely to reduce bleeding during cardiac and orthopedic surgery, but its safety and efficacy in noncardiac surgery have not been established. In this randomized trial, 9500 patients (mean age, 70) from 22 countries who were at excess risk for perioperative cardiovascular complications and bleeding were assigned to receive two 1-g doses of tranexamic acid or placebo during noncardiac (mostly intraabdominal and orthopedic) surgery. The primary efficacy outcome was serious bleeding complications; the primary safety outcome was cardiovascular complications, given concerns about thrombotic effects of this drug.
At 30 days, patients who received tranexamic acid experienced significantly less l…