Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
5028 participants
INTERVENTIONAL
2014-01-20
2017-10-01
Brief Summary
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
OTHER
NONE
Study Groups
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Restrictive transfusion strategy
Restrictive transfusion strategy: patients will receive a red cell transfusion if their hemoglobin is \<75 g/L (\<7.5 g/dL;\<4.7mmol/L) intraoperatively and/or postoperatively
Restrictive Transfusion Strategy
Liberal transfusion strategy
Liberal transfusion strategy: patients will receive a red cell transfusion if their hemoglobin concentration is \<95 g/L (\<9.5 g/dL\<5.9mmol/L) intraoperatively, or postoperatively in the intensive care unit; and/or \<85 g/L (\< 8.5 g/dL;\<5.3mmol/L) on the ward.
Liberal transfusion strategy
Interventions
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Restrictive Transfusion Strategy
Liberal transfusion strategy
Eligibility Criteria
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Inclusion Criteria
* Planned cardiac surgery using cardiopulmonary bypass
* Informed consent obtained
* Preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more
Exclusion Criteria
* Patients who are involved in a preoperative autologous pre-donation program
* Patients who are having a heart transplant or having surgery solely for an insertion of a ventricular assist device
* Pregnancy or lactation (a negative pregnancy test must be obtained prior to randomization for women of childbearing potential.)
* Patients who are unable to receive or who refuse blood products
18 Years
ALL
No
Sponsors
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Unity Health Toronto
OTHER
Responsible Party
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Principal Investigators
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David Mazer, MD
Role: PRINCIPAL_INVESTIGATOR
Unity Health Toronto
Nadine Shehata, MD
Role: PRINCIPAL_INVESTIGATOR
MOUNT SINAI HOSPITAL
Richard Whitlock, MD
Role: PRINCIPAL_INVESTIGATOR
McMaster University
Dean Fergusson, MD
Role: PRINCIPAL_INVESTIGATOR
Ottawa Hospital Research Institute
Kevin Thorpe, MSc
Role: PRINCIPAL_INVESTIGATOR
University of Toronto
Locations
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San Francisco VA Medical Center
San Francisco, California, United States
Yale-New Haven Hospital
New Haven, Connecticut, United States
Maine Medical Center
Portland, Maine, United States
Montefiore Medical Center
The Bronx, New York, United States
Durham Veterans Affairs Medical Center
Durham, North Carolina, United States
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Baylor College of Medicine
Houston, Texas, United States
Michael E. DeBakey Veterans Affairs Medical Center
Houston, Texas, United States
Royal Prince Alfred Hospital
Camperdown, New South Wales, Australia
Royal North Shore Hospital
Sydney, New South Wales, Australia
Westmead Hospital
Westmead, New South Wales, Australia
Royal Adelaide Hospital
Adelaide, South Australia, Australia
Flinders Medical Centre
Bedford Park, South Australia, Australia
Monash Medical Centre
Clayton, Victoria, Australia
St Vincent's Hospital, Melbourne
Fitzroy, Victoria, Australia
Austin Hospital
Heidelberg, Victoria, Australia
Cabrini Health
Malvern, Victoria, Australia
Alfred Hospital
Melbourne, Victoria, Australia
Barwon Health (University Hospital Geelong)
Melbourne, Victoria, Australia
Royal Melbourne Hospital
Parkville, Victoria, Australia
Hospital Unimed Rio (National Institute of Cardiology)
Rio de Janeiro, , Brazil
Foothills Medical Centre
Calgary, Alberta, Canada
University of Alberta
Edmonton, Alberta, Canada
Kelowna General Hospital
Kelowna, British Columbia, Canada
Vancouver General Hospital
Vancouver, British Columbia, Canada
St Boniface Hospital
Winnipeg, Manitoba, Canada
Saint John Regional Hospital
Saint John, New Brunswick, Canada
Health Sciences Centre (Memorial University)
St. John's, Newfoundland and Labrador, Canada
QEII Health Science Centre
Halifax, Nova Scotia, Canada
Hamilton General Hospital
Hamilton, Ontario, Canada
Kingston General Hospital
Kingston, Ontario, Canada
London Health Sciences Center
London, Ontario, Canada
Southlake Regional Health Centre
Newmarket, Ontario, Canada
University of Ottawa Heart Institute
Ottawa, Ontario, Canada
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
St Michael's Hospital
Toronto, Ontario, Canada
University Health Network Toronto General Hospital
Toronto, Ontario, Canada
Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ)
Chemin Sainte-Foy, Quebec, Canada
Montreal Heart Institute
Montreal, Quebec, Canada
SMBD Jewish General Hospital
Montreal, Quebec, Canada
Hôpital du Sacré-Cœur de Montréal
Montreal, Quebec, Canada
Centre hospitalier de l'Université de Montréal
Montreal, Quebec, Canada
Centre Hospitalier Universitaire de Sherbrooke
Sherbrooke, Quebec, Canada
Shanghai Yodak Cardio-Thoracic Hospital
Shanghai, , China
Renji Hospital
Shanghai, , China
Instituto del Corazón de Bucaramanga
Bucaramanga, Santander Department, Colombia
Clinica de Marly
Bogotá, , Colombia
Fundacion Cardioinfantil Instituto de Cardiologia
Bogotá, , Colombia
Fundación Clínica Shaio
Bogotá, , Colombia
Hospital De San Jose
Bogotá, , Colombia
Rigshospitalet - Copenhagen University Hospital
Copenhagen, , Denmark
Tanta University Hospital
Tanta, , Egypt
Charité - Universitätsmedizin Berlin
Berlin, , Germany
University Hospital Giessen
Giessen, , Germany
University of Thessaly
Volos, , Greece
Narayana Health
Bangalore, Karnataka, India
SAL Hospital
Gujarat, , India
Sheba Medical Center
Ramat Gan, , Israel
Tel Aviv Sourasky Medical Centre
Tel Aviv, , Israel
Institut Jantung Negara
Kuala Lampur, , Malaysia
Auckland City Hospital
Auckland, , New Zealand
Christchurch Hospital
Christchurch, , New Zealand
Dunedin Hospital
Dunedin, , New Zealand
Waikato Hospital
Hamilton, , New Zealand
Wellington Hospital
Wellington, , New Zealand
Emergency Institute for Cardiovascular Diseases
Târgu Mureş, , Romania
National Heart Centre Singapore
Singapore, , Singapore
University of KwaZulu-Natal
Durban, KwaZulu-Natal, South Africa
Hospital de la Santa Creu i Sant Pau
Barcelona, , Spain
Hospital Ramón y Cajal
Madrid, , Spain
Consorcio Hospital General Universitario de Valencia
Valencia, , Spain
Instituto de Investigación Sanitaria Hospital Univ. & Politc. La Fe de Valencia
Valencia, , Spain
University Hospital Basel
Basel, , Switzerland
University Hospital Bern (Inselspital)
Bern, , Switzerland
Countries
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References
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Carson JL, Stanworth SJ, Dennis JA, Fergusson DA, Pagano MB, Roubinian NH, Turgeon AF, Valentine S, Trivella M, Doree C, Hebert PC. Transfusion thresholds and other strategies for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2025 Oct 20;10:CD002042. doi: 10.1002/14651858.CD002042.pub6.
Mistry N, Hare GMT, Shehata N, Kramer RS, Fawzy HF, Baker RA, Carmona P, Saczkowski R, Filipescu D, Alphonsus CS, Rochon A, Gregory AJ, Khanykin B, Leff JD, Mateo E, Karangelis D, Tellez JC, Saha T, Ko DT, Wijeysundera DN, Verma S, Mazer CD. Methemoglobin as a marker of acute anemic stress in cardiac surgery. iScience. 2023 Jul 20;26(8):107429. doi: 10.1016/j.isci.2023.107429. eCollection 2023 Aug 18.
Sankar A, Rotstein AJ, Teja B, Carrier FM, Belley-Cote EP, Bolliger D, Saha T, Carmona P, Sander M, Shehata N, Thorpe KE, Mazer CD. Prolonged mechanical ventilation after cardiac surgery: substudy of the Transfusion Requirements in Cardiac Surgery III trial. Can J Anaesth. 2022 Dec;69(12):1493-1506. doi: 10.1007/s12630-022-02319-9. Epub 2022 Sep 19.
Carson JL, Stanworth SJ, Dennis JA, Trivella M, Roubinian N, Fergusson DA, Triulzi D, Doree C, Hebert PC. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021 Dec 21;12(12):CD002042. doi: 10.1002/14651858.CD002042.pub5.
Mazer CD, Whitlock RP, Fergusson DA, Belley-Cote E, Connolly K, Khanykin B, Gregory AJ, de Medicis E, Carrier FM, McGuinness S, Young PJ, Byrne K, Villar JC, Royse A, Grocott HP, Seeberger MD, Mehta C, Lellouche F, Hare GMT, Painter TW, Fremes S, Syed S, Bagshaw SM, Hwang NC, Royse C, Hall J, Dai D, Mistry N, Thorpe K, Verma S, Juni P, Shehata N; TRICS Investigators and Perioperative Anesthesia Clinical Trials Group. Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery. N Engl J Med. 2018 Sep 27;379(13):1224-1233. doi: 10.1056/NEJMoa1808561. Epub 2018 Aug 26.
Garg AX, Shehata N, McGuinness S, Whitlock R, Fergusson D, Wald R, Parikh C, Bagshaw SM, Khanykin B, Gregory A, Syed S, Hare GMT, Cuerden MS, Thorpe KE, Hall J, Verma S, Roshanov PS, Sontrop JM, Mazer CD. Risk of Acute Kidney Injury in Patients Randomized to a Restrictive Versus Liberal Approach to Red Blood Cell Transfusion in Cardiac Surgery: A Substudy Protocol of the Transfusion Requirements in Cardiac Surgery III Noninferiority Trial. Can J Kidney Health Dis. 2018 Jan 3;5:2054358117749532. doi: 10.1177/2054358117749532. eCollection 2018.
Shehata N, Whitlock R, Fergusson DA, Thorpe KE, MacAdams C, Grocott HP, Rubens F, Fremes S, Lellouche F, Bagshaw S, Royse A, Rosseel PM, Hare G, Medicis E, Hudson C, Belley-Cote E, Bainbridge D, Kent B, Shaw A, Byrne K, Syed S, Royse CF, McGuiness S, Hall J, Mazer CD. Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design of a Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):121-129. doi: 10.1053/j.jvca.2017.10.036. Epub 2017 Nov 3.
Mazer CD, Whitlock RP, Fergusson DA, Hall J, Belley-Cote E, Connolly K, Khanykin B, Gregory AJ, de Medicis E, McGuinness S, Royse A, Carrier FM, Young PJ, Villar JC, Grocott HP, Seeberger MD, Fremes S, Lellouche F, Syed S, Byrne K, Bagshaw SM, Hwang NC, Mehta C, Painter TW, Royse C, Verma S, Hare GMT, Cohen A, Thorpe KE, Juni P, Shehata N; TRICS Investigators and Perioperative Anesthesia Clinical Trials Group. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. N Engl J Med. 2017 Nov 30;377(22):2133-2144. doi: 10.1056/NEJMoa1711818. Epub 2017 Nov 12.
Other Identifiers
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301852
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
TRICSIII
Identifier Type: -
Identifier Source: org_study_id
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