Traction Trial
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Study overview
Recruitment
Closed to recruitment March 5, 2024.
Number of patients enrolled: 8428
Number of Sites: 10
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Overview
A Phase IV trial of a hospital policy of Tranexamic acid use to reduce transfusion in major non-cardiac surgery (TRACTION)

Tranexamic Acid to Reduce Transfusion in Major Non-Cardiac Surgery
TRIAL SYNOPSIS
| Title | A Phase IV trial of a hospital policy of Tranexamic acid use to reduce transfusion in major non-cardiac surgery (TRACTION) |
| Short title | Tranexamic acid to reduce transfusion in major non-cardiac surgery |
| Trial design | Pragmatic, randomized cluster-crossover trial. |
| Planned sample size of trial participants | Approximately 8320 patients 18 years of age and with Increased local fibrinolysis undergoing surgeries known to have a baseline transfusion rate of 5% or greater. |
| Investigational Medicinal Product(s) | Tranexamic acid (TXA) |
| Formulation, Dose, Route of Administration | TXA 1 gram intravenous bolus followed by 1 additional gram prior to skin closure. |
| Duration | From first surgical incision until skin closure. |
| Follow Up Duration | 90 days |
| Planned Trial Period | 18 months |
| Co-primary outcomes | Proportion of patients transfused red blood cells (RBCs); and Incidence of deep vein thrombosis or pulmonary embolus within 3 months of surgery. |
| Secondary outcomes | Transfusion: The number of RBC units transfused, both at an individual-level and at a cluster-level Safety: In-hospital diagnosis of myocardial infarction, stroke, deep vein thrombosis or pulmonary embolus Clinical: Hospital length of stay, ICU admission, hospital survival, 3-month survival, and the number of days at home to day 30 (DAH30) Compliance: proportion of eligible patients who receive the policy intervention, and the policy compliance in enrolled patients. |
FUNDERS AND COLLABORATORS






MEDIA AND COMMUNICATIONS

TRACTION TEAM
Primary trial investigators and coordinating centre
Dr. Zarychanski is a Professor, Critical Care physician, Hematologist, and Clinician-Scientist at the University of Manitoba and CancerCare Manitoba. He’s a senior scientist at the Research Institute of Oncology and Hematology and an affiliate member of the George and Fay Yee Centre for Healthcare Innovation. His research focuses on the hematologic aspects of critical illness where he leads several national and international randomized trials in the fields of sepsis and transfusion medicine.
Dr. Houston is an Assistant Professor, Hematologist, and Clinician-Scientist at the University of Manitoba and CancerCare Manitoba. Her PhD thesis focused on the use of tranexamic acid to reduce bleeding in non-cardiac surgeries at high-risk for red blood cell transfusion. Her ongoing research programs focus on supportive care strategies to reduce bleeding in patients at the time of surgery, and in patients with underlying blood cancers.
Robert Balshaw is an Assistant professor in the department of community health sciences and a senior biostatistician in the Data Science Platform of the Georgy and Fay Yee Centre for Healthcare Innovation. He has been a consulting biostatistician for industry, government, and academia for 35 years and has been the lead statistician for dozens of clinical trials and consulted on hundreds of research projects.
Dayna Solvason is a Research Project Manager with over 16 years of experience in academic and industry-sponsored clinical health research. She specializes in clinical trial operations of multi-center national and international clinical trials, including clinical trial agreements, and international clinical trial insurance requirements. Dayna also provides strategic support to investigators and research teams in the development of competitive grant applications and funding proposals. Her contributions have helped secure more than $20 million in research funding, supporting innovative clinical research programs and advancing healthcare knowledge and patient outcomes both nationally and internationally.
Dr. McIsaac is an anesthesiologist and CIHR-funded scientist who combines expertise in data science and clinical trials to improve the outcomes of older people having surgery. Primary focuses in Dr. McIsaac’s research include improving perioperative care for older people with frailty, assessing health system performance, and utilization of patient reported outcomes.
Dr. Fergusson is a Senior Scientist and Director of the Clinical Epidemiology Program at the Ottawa Hospital Research Institute and Full Professor in the Department of Medicine. His expertise spans transfusion medicine and innovative clinical trial methodology, having led landmark trials that shaped international blood management practices.
Dr. Breau is a Surgical Oncologist, Scientist, and Full Professor of Surgery at the University of Ottawa/Ottawa Hospital Research Institute. He serves on international guidelines committees for oncology and urology and leads several multicenter clinical trials. He also serves as surgical lead for the Canadian Kidney Cancer Information System, a national prospective cohort of over 18,000 patients.
Dr. Ramsay holds a PhD in biostatistics and is a Senior Scientist with the Clinical Epidemiology Program at the Ottawa Hospital Research Institute and Associate Professor at the University of Ottawa. He is Scientific Director of the Ottawa Methods Centre, supporting clinical research across Ontario. He has authored 229 peer-reviewed publications and co-investigated grants totaling over $66 million.
Site investigators and research coordinators
Dr. Tenenbein is an Assistant Professor at the University of Manitoba in the Department of Anesthesiology, Perioperative and Pain Medicine. He completed his Medical degree, BSc(Med), Anesthesia residency and Simulation fellowship all at the University of Manitoba. He is currently the Anesthesia Site Lead at the Health Sciences in Winnipeg.
Angela Recio is an internationally trained Medical Doctor specialized in Anesthesia and Pediatric Anesthesia. After almost 20 years of Clinical experience as an anesthesiologist in Latin America, Angela is now devoted to Clinical Research, a field she had previously worked on while supervising Anesthesia Residents and as a Fellow in the United States.
Dina Muhammad is a Medical Doctor specialized in Gynecology and Obstetrics internationally. Dina joined the TRACTION Team in late November 2022 and very rapidly she has become an amazing dynamic, strong, independent, self-teaching, fast learning and reliable key member to the team. Dina had always been interested in Clinical Research and is now enjoying being able to work on it full time.
Dr. Bagry moved to Canada in 2007 after completing FRCA in the UK. Since then, she have worked as a clinical anesthesiologist at St Boniface hospital and Misericordia eye hospital. Her subspecialty interest is in obstetric anesthesia.
Michelle Mola is a Research Associate in the Department of Internal Medicine and Critical Care at the University of Manitoba and serves as lead Clinical Research Coordinator for the TRACTION study at St. Boniface Hospital. She holds an M.D. from Our Lady of Fatima University and brings a background in pediatric medicine and clinical research.
Lucas Mosienko holds a Bachelor of Science in Neuroscience from the University of Winnipeg and is currently a medical student at the University of Manitoba. He previously served as lead TRACTION coordinator at St. Boniface Hospital and has clinical research experience across anesthesia, pediatric endocrinology, palliative care, and neuroscience. He continues to support the TRACTION study throughout medical school.
Oleksandra Stadnyk holds a medical degree from Ivano-Frankivsk Medical University in Ukraine and brings 17 years of experience as an Anesthesiologist in ICU, OR, and Emergency settings. She joined Dr. Zarychanski’s team in 2022 and recruited for the TRACTION, REMAP-CAP, and REVISE clinical trials.
Dr. McIsaac is an anesthesiologist and CIHR-funded scientist who combines expertise in data science and clinical trials to improve the outcomes of older people having surgery. Primary focuses in Dr. McIsaac’s research include improving perioperative care for older people with frailty, assessing health system performance, and utilization of patient reported outcomes. In addition to his role on the TRACTION team, Dr. McIsaac is currently leading or co-leading two national multicenter studies to improve postoperative outcomes using exercise prehabilitation (PREPARE Trial) and to better understand recovery trajectories after surgery in older people (FIT After Surgery Study).
Dr. Breau is a Surgical Oncologist, Scientist, and Associate Professor of Urology at The University of Ottawa/Ottawa Hospital Research Institute. He attended medical school at Dalhousie University and urology residency at the University of Ottawa. He completed his Urologic Oncology and Robotic Surgery Fellowship at Mayo Clinic and received a Master of Science in Clinical and Translational Research from Mayo School of Graduate Medical Education. Dr. Breau serves on numerous American Urological Association, Canadian Urological Association, and Cancer Care Ontario leadership committees. He is the primary investigator of several multicenter surgical trials in urologic oncology.
Emily Hladkowicz is the PREPARE Trial Coordinator. Emily has been working at the OHRI since she completed her Psychology degree in 2011. Emily completed her Masters in Counselling Psychology at the University of Ottawa and is currently a PhD student in the Aging & Health program at Queen’s University. With the AIMS research team, Emily helps to coordinate several clinical trials and is involved in various knowledge synthesis projects as well. Her PhD research will focus on synthesizing how successful postoperative transitions have been defined in the literature and to understand whether these definitions align with the needs and values of older adults with frailty and their caregivers.
Noha Khalil joined the AIMS Research Team as a Research Assistant in January 2022, taking a lead role on the TRACTION Trial at The Ottawa Hospital’s Civic and General campuses. She earned her medical degree from Ain Shams University in Egypt in 2011 and completed formal training in Anesthesia, Intensive Care, and Pain Management, with significant involvement in anesthesia research. Her clinical and research expertise in anesthesia makes her a valuable contributor to Dr. McIsaac’s research program, particularly in regulated drug trials and the OR setting.
Karine Brousseau is a research coordinator for the liver and pancreas surgical unit at the OHRI and has also joined the AIMS team in August 2022 to work on the TRACTION trial. She has been working on various international and multicenter trials and developed great interest and experience in research related to perioperative medicine and transfusion medicine. Alongside her work experience, Karine is currently completing her Master’s degree in Epidemiology at the University of Ottawa.
Dr. Saha MB, BS, FRCPC is an Associate Professor in the Department of Anesthesiology & Perioperative Medicine, Queen’s University. Within the department, he is both the Director of Cardiac Anesthesia and Director of Anesthesiology Research. He is an investigator in several CIHR and Industry funded Cardiac Anesthesia and Surgery multicenter clinical trials. His primary research interests include blood conservation & chronic pain after cardiac surgery.
Aftab Malik is a Research Associate/Project Coordinator in the Department of Anesthesiology & Perioperative Medicine, Queen’s University. He completed his Masters in Physical Therapy from Jamia Hamdard University, New Delhi, India is 2009 and practiced for 6 years. Upon moving to Canada he worked as Resident Physical Therapist for some time and became interested in Clinical Research. He completed his Post Graduate Diploma in Clinical Research from Oxford College in Mississauga. He then joined St. Michael’s Hospital, Toronto, as Research Assistant where he worked on multiple industry sponsored research projects.
Shagun Jain, BSc(H), is a Research Assistant in the Department of Anesthesiology and Perioperative Medicine at Kingston Health Sciences Centre (KHSC)/Queen’s University. She completed her undergraduate education at Queen’s University, with a Specialization in Kinesiology and a Certificate in Disability and Physical Activity. Since joining the department in September 2022, Shagun has been actively involved in several trials at KHSC, including the TRACTION trial.
Bethany Smethurst, BHSc, has been working as a Research Assistant in the Department of Anesthesiology and Perioperative Medicine at Kingston Health Sciences Centre (KHSC) since July 2021. She completed her undergraduate degree at Queen’s University in Health Sciences with an Applied Research Methods learning track. TRACTION is one of many trials Bethany supports in her role at KHSC.
Reegan Tod graduated from McMaster University with an Honours Bachelor of Science in Physiology Research. Since 2018, Reegan has worked with the Department of Anesthesia at KHSC in various research assistant roles and now supports the team full-time. Reegan is involved in several clinical research studies, including the TRACTION Trial, contributing to ongoing advancements in perioperative and anesthesia research.
Dr. McIsaac is an Anesthesiologist and Intensivist. She is the current Medical Director of Faculty Development and an Assistant Professor at the Northern Ontario School of Medicine. She is passionate about resuscitation, wellness, medical education and organizational change management. She is the very proud co-founder of Northern City of Heroes, a community initiative to teach hands-only CPR for free to the general public. She recently helped create and develop the first CPR exhibit in the world at Science North in Sudbury, Ontario. In her spare time you will find her exploring Northern Ontario with her husband, two amazing children and two dogs.
Dr. Duncan is an Assistant Professor and Staff Anesthesiologist in the Department of Anesthesia at the Northern Ontario School of Medicine in Sudbury. Following her medical degree at the University of British Columbia, Dr. Duncan completed her anesthesiology residency at the University of Ottawa. She went on to complete fellowship training at the University of Manitoba, obtaining fellowships in both Cardiac Anesthesiology and Perioperative Medicine. Dr. Duncan is a Diplomate of the American Board of Echocardiography (advanced perioperative transesophageal echocardiography). Her interests include perioperative optimization of the high-risk surgical patient and perioperative care in cardiac surgery.
Katie Runions is the lead Health Sciences North Clinical Research Coordinator at the site in Sudbury, Ontario. Katie has her Master of Science Communication and has previously worked as a research and evaluation assistant at a science centre. In addition to her research experience, Katie also has several years of project management experience and has held multiple coordinator and leadership roles.
Taylor Karn is a clinical research coordinator based in Sudbury, Ontario, working at Health Sciences North. He holds an undergraduate degree in Biomedical Biology and has previously demonstrated his leadership skills in the biotechnology and microbiology research fields. Taylor’s dedicated to enhancing the overall health and safety of individuals within his community.
Dr. Andrews is a staff anesthesiologist at the Montfort Hospital and a lecturer in the University of Ottawa Faculty of Medicine. After completing her residency training at McMaster University, she completed a fellowship in Medical Education and Simulation with the University of Ottawa’s Department of Anesthesia and Pain Medicine. She currently serves as the Director of Research for the Department of Anesthesiology at the Montfort Hospital.
Mélodie Potvin holds an Honours Bachelor of Science in Nursing from the University of Ottawa obtained in 2010. She began working as a clinical research coordinator at the Institut du Savoir Montfort in 2019. Since, she has worked in various research therapeutic areas such as in thrombosis, in cardiology, in gastroenterology and COVID-19 disease. Her combined professional experiences as a nurse, clinical care coordinator, clinical manager and in research have permitted to leverage her clinical trials management and coordination skills.
Christine-Nadia Compas is a Clinical Research Coordinator at Institut du Savoir Montfort. After completing her Registered Practical Nurse studies, she pursues her undergraduate studies in Social Sciences/Psychology and completed her Graduate studies in Clinical Research. She also has a training in Clinical Research Project/Program Management. She is currently a Master candidate in Mental health, health and social services management. Christine-Nadia is Network of networks (N2) designated representative for Hôpital Montfort and the administrator of the CITI program platform at the hospital.
Dr. Avramescu is an anesthesiologist at Humber River Hospital and Assistant Professor at the University of Toronto. She holds a PhD in Neurobiology and completed her anesthesia residency and postdoctoral studies in Translational Medicine at the University of Toronto. Her research focuses on perioperative brain health, spanning bench research to clinical trials, with findings published in top medical journals and recognized by national and international awards. She currently serves as Executive Director and Director of Research in the Anesthesia Department at Humber River Hospital, where she established the hospital’s first perioperative research program and leads several clinical trials and quality improvement projects.
Dr. Kerelska is a community anesthesiologist at Humber River Hospital, where she has practiced since 2015. She obtained her medical degree from McMaster University and completed her anesthesiology residency at the University of Toronto in 2014. Driven by a passion for improving patient care, she went on to complete a Master of Science in Quality Improvement and Patient Safety at the University of Toronto. She has been involved in quality improvement initiatives at Humber River Hospital, helped create its first perioperative research program, and currently serves as site co-investigator for several multicenter clinical trials.
Seema Charummoottil is a Clinical Research Coordinator at Humber River Hospital. She currently supports various studies conducted in the surgical space. She holds a BSc (Hons) with a specialization in Mental Health and Human Biology from the University of Toronto. In her spare time, she enjoys travelling, baking and spending time with family and friends.
Gurnoor Kaur is a Clinical Research Coordinator with a background in clinical trial recruitment and quality assurance. She holds a Bachelor’s degree in Pharmacy and a postgraduate diploma in Healthcare Management. She currently coordinates studies in oncology and surgical research, and is committed to staying current with the latest advancements and regulatory guidelines in clinical research.
Dr. Harle is an Associate Professor in the Department of Anesthesia & Perioperative Medicine at Western University. He is a cardiac and liver transplant Anesthesiologist with an interest in Patient Blood Management and collaborative research. Dr. Harle is Chair of the London Health Sciences Centre City Wide Blood Transfusion Committee, and Medical Director of the Patient Blood Management Program and a past Chair of Ontario’s Anesthesiologists.
Bio coming soon!
Bio coming soon!
Lee-Anne Fochesato is the Research Coordinator for the Department of Anesthesia and Perioperative Medicine at Western University. Lee-Anne has a Master’s of Science degree in Biochemistry and has close to 10 years of experience working in the field of clinical trials organization.