The POISE-3 study randomised patients having noncardiac surgery to tranexamic acid (TXA) or placebo. The incidence of bleeding outcome was significantly lower with TXA (9.1%) than with placebo (11.7%) (hazard ratio, 0.76; 95% CI, 0.67 to 0.87). The incidence of the safety outcome (myocardial injury, stroke, arterial thrombosis, VTE) was 14.2% in the TXA group and 13.9% in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14) but non-inferiority was not established. As the absolute difference in the safety outcome was small, wider use of TXA in noncardiac surgery seems justified. As TXA is inexpensive these results will be rapidly translated into practice in Australia.
The results of the tranexamic arm was presented at the ANZCA Annual Scientfic Meeting 2022 by Dr Tom Painter.
POISE-3 is a multicentre, international, randomised controlled trial of tranexamic acid (TXA) versus placebo and, using a partial factorial, of a perioperative hypotension avoidance versus hypertension-avoidance strategy in adults undergoing non cardiac surgery.
Sample Size
10000 patients
Study Duration
Five years
Primary outcomes
The co-primary efficacy outcome for the TXA trial is a composite of life-threatening bleeding, major bleeding, and critical organ bleeding at 30 days after randomisation. The co-primary safety outcome for the TXA trial is a composite of myocardial injury after noncardiac surgery (MINS), non-haemorrhagic stroke, peripheral arterial thrombosis, and symptomatic proximal venous thromboembolism at 30 days after randomisation. The primary outcome for the blood pressure management trial is a composite of vascular death, and non-fatal MINS, stroke, and cardiac arrest 30 days after randomisation.
Canadian Institutes of Health Research and others.
The Australian and New Zealand arm was supported by the Australian National Health and Medical Research Council.
From 2018 to 2021, the study recruited 9561 patients across 149 sites in 24 countries. The ANZCA CTN made an outstanding contribution to the trial with a total of 743 patients recruited across 20 centres between April 2019 and July 2021.
ClinicalTrials.gov number, NCT03505723
| Australian hospitals |
| Austin Health |
| Box Hill Hospital |
| Dandenong Hospital |
| Fiona Stanley Hospital |
| Flinders Medical Centre |
| Goulburn Valley Health |
| John Hunter Hospital |
| Peter Mac Hospital |
| Prince of Wales Hospital |
| Princess Alexandra Hsopital |
| Queen Elizabeth II Jubilee Hospital |
| Royal Adelaide Hospital |
| Royal Hobart Hospital |
| Royal Melbourne Hospital |
| Royal Perth Hospital |
| Western Health Sunshine, Williamstown and Footscray Hospitals |
| Westmead Hospital |
| New Zealand hospitals |
| Auckland City Hsopital |
| Middlemore and Manukau Hospital |
| Waikato Hospital |
Media release
Devereaux PJ, Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, Chan MTV, Borges FK, Martínez-Zapata MJ, Wang CY, Xavier D, Ofori SN, Wang MK, Efremov S, Landoni G, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Duceppe E, Ruetzler K, Parlow JL, Tandon V, Fleischmann E, Polanczyk CA, Lamy A, Astrakov SV, Rao M, Wu WKK, Bhatt K, de Nadal M, Likhvantsev VV, Paniagua P, Aguado HJ, Whitlock RP, McGillion MH, Prystajecky M, Vincent J, Eikelboom J, Copland I, Balasubramanian K, Turan A, Bangdiwala SI, Stillo D, Gross PL, Cafaro T, Alfonsi P, Roshanov PS, Belley-Côté EP, Spence J, Richards T, VanHelder T, McIntyre W, Guyatt G, Yusuf S, Leslie K; POISE-3 Investigators. Tranexamic Acid in Patients Undergoing Noncardiac Surgery. N Engl J Med. 2022 Apr 2. doi: 10.1056/NEJMoa2201171. Epub ahead of print. PMID: 35363452.
Marcucci M, Painter TW, Conen D, Leslie K, Lomivorotov VV, Sessler D, Chan MTV, Borges FK, Martínez Zapata MJ, Wang CY, Xavier D, Ofori SN, Landoni G, Efremov S, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Duceppe E, Ruetzler K, Parlow JL, Tandon V, Wang MK, Fleischmann E, Polanczyk CA, Jayaram R, Astrakov SV, Rao M, VanHelder T, Wu WKK, Cheong CC, Ayad S, Abubakirov M, Kirov M, Bhatt K, de Nadal M, Likhvantsev V, Iglesisas PP, Aguado HJ, McGillion M, Lamy A, Whitlock RP, Roshanov P, Stillo D, Copland I, Vincent J, Balasubramanian K, Bangdiwala SI, Biccard B, Kurz A, Srinathan S, Petit S, Eikelboom J, Richards T, Gross PL, Alfonsi P, Guyatt G, Belley-Cote E, Spence J, McIntyre W, Yusuf S, Devereaux PJ. Rationale and design of the PeriOperative ISchemic Evaluation-3 (POISE-3): a randomized controlled trial evaluating tranexamic acid and a strategy to minimize hypotension in noncardiac surgery. Trials. 2022 Jan 31;23(1):101. doi: 10.1186/s13063-021-05992-1. PMID: 35101083; PMCID: PMC8805242.