Related Experiment Video
Updated: Feb 16, 2026
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design of a Randomized Controlled Trial
Nadine Shehata1, Richard Whitlock2, Dean A Fergusson3
1Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, Ontario, Canada.
A restrictive red blood cell transfusion strategy was noninferior to a liberal strategy for patients undergoing cardiac surgery. This finding impacts transfusion guidelines for cardiac surgery patients, optimizing outcomes and resource use.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Critical Care Medicine
Background:
- Cardiac surgery patients often require blood transfusions.
- Transfusion strategies vary, with ongoing debate regarding optimal hemoglobin thresholds.
- The TRICS III trial addresses the safety and efficacy of different transfusion thresholds in this population.
Purpose of the Study:
- To compare a restrictive red blood cell (RBC) transfusion threshold with a liberal threshold in patients undergoing cardiac surgery.
- To determine if a restrictive strategy is noninferior to a liberal strategy regarding mortality and serious morbidity.
Main Methods:
- Multicenter, international, open-label randomized controlled trial (TRICS III).
- 1:1 randomization of patients (≥18 years) undergoing cardiac surgery with cardiopulmonary bypass and high EuroSCORE I.
- Restrictive group: RBC transfusion if hemoglobin <7.5 g/dL. Liberal group: RBC transfusion if hemoglobin <9.5 g/dL (intra/post-op ICU) or <8.5 g/dL (ward).
Main Results:
- The primary outcome was a composite of mortality, myocardial infarction, stroke, or new renal dysfunction requiring dialysis.
- Analysis was performed using a per-protocol approach to ensure adherence to transfusion triggers.
- The study aimed to capture the acute hemoglobin reduction during cardiopulmonary bypass through pre-operative randomization.
Conclusions:
- A restrictive red blood cell transfusion strategy is noninferior to a liberal strategy in patients undergoing cardiac surgery.
- The findings support the use of more conservative transfusion thresholds in this patient population.
- This study provides evidence to guide transfusion practices in cardiac surgery, potentially improving patient outcomes and managing blood product resources.
