Oral Versus Intravenous Tranexamic Acid in Off-Pump Coronary Artery Bypass Surgery (TRANSCAB)

Oral Versus Intravenous Tranexamic Acid for Blood Loss Prevention in Off-Pump Coronary Artery Bypass Surgery: A Randomized Double-Blind Non-Inferiority Trial

Tranexamic acid is commonly administered intravenously during cardiac surgery to reduce perioperative bleeding. Oral tranexamic acid may offer a simpler and less costly alternative, but its effectiveness in patients undergoing off-pump coronary artery bypass grafting has not been adequately established.

TRANSCAB is a randomized, double-blind, parallel-group, non-inferiority clinical trial comparing oral and intravenous tranexamic acid in adults undergoing elective off-pump coronary artery bypass grafting. Participants will receive either oral tranexamic acid before surgery with an intravenous placebo at induction, or oral placebo before surgery with intravenous tranexamic acid at induction.

The primary objective is to determine whether oral tranexamic acid is non-inferior to intravenous tranexamic acid for reducing postoperative blood loss. Secondary objectives include comparing transfusion requirements, postoperative hemoglobin levels, reoperation for bleeding, thromboembolic complications, seizures, acute kidney injury, and other postoperative outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Coronary Artery Disease; Perioperative Bleeding
• Intervention / Treatment: Drug: Oral tranexamic acid; Drug: Intravenous placebo; Drug: Exacyl®

Detailed Description

Perioperative bleeding remains an important complication of coronary artery bypass surgery and may lead to blood transfusion, reoperation, prolonged hospitalization, and increased postoperative morbidity. Tranexamic acid is an antifibrinolytic drug widely used in cardiac surgery to reduce bleeding and transfusion requirements. It is most commonly administered intravenously, although oral administration may provide adequate systemic exposure while simplifying drug preparation and administration.

TRANSCAB is a monocentric, prospective, randomized, double-blind, placebo-controlled, parallel-group, non-inferiority trial conducted in adult patients undergoing elective off-pump coronary artery bypass grafting.

A total of 160 participants will be randomized in a 1:1 ratio to one of two treatment groups:

1. Oral tranexamic acid group: four 500 mg tranexamic acid tablets administered approximately 2 hours before surgical incision, together with an intravenous placebo administered at induction or incision according to the study protocol.
2. Intravenous tranexamic acid group: four matching oral placebo tablets administered approximately 2 hours before surgical incision, together with 1 g intravenous tranexamic acid administered at induction or incision according to the study protocol.

Participants, clinicians involved in perioperative management, outcome assessors, and investigators will remain blinded to treatment allocation. Study treatments will be prepared and dispensed according to the randomization list by the hospital pharmacy.

The primary objective is to assess whether oral tranexamic acid is non-inferior to intravenous tranexamic acid in reducing postoperative blood loss following off-pump coronary artery bypass grafting.

Secondary and safety outcomes will assess perioperative transfusion requirements, postoperative hemoglobin changes, clinically significant bleeding, reoperation for bleeding, thromboembolic events, seizures, acute kidney injury, mortality, duration of intensive care and hospital stay, and other postoperative complications specified in the protocol.

• Study Type: Interventional
• Enrollment (Estimated): 160
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Benjamin Javillier, MD; Phone Number: +32 081 20 91 55; Email: benjamin.javillier@slbo.be

Study Locations

• Belgium
  • Namur
    • Bouge, Namur, Belgium, 5004
      • Clinique Saint-Luc
      • Contact: Benjamin Javillier, MD; Phone Number: +32 081209155; Email: benjamin.javillier@slbo.be

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age 18 years or older.
2. Elective isolated coronary artery bypass grafting planned without cardiopulmonary bypass, including off-pump coronary artery bypass through sternotomy or minimally invasive/direct or totally endoscopic coronary artery bypass surgery. Conversion to cardiopulmonary bypass is permitted if clinically required.
3. Perioperative tranexamic acid planned as part of routine care, with the participant eligible for both oral and intravenous administration according to the applicable product information and local policy.
4. Written informed consent obtained before randomization.
5. Routine preoperative laboratory results available, including at least hemoglobin and serum creatinine measured within 30 days before surgery.
6. Available for in-hospital follow-up and Day 30 assessment.

Exclusion Criteria:

1. Emergency surgery, non-isolated cardiac surgery, or planned on-pump coronary artery bypass grafting.
2. Inability to provide informed consent or comply with the required follow-up.
3. Hypersensitivity to tranexamic acid or any excipient of the study products.

4. Contraindication or clinically relevant precaution to tranexamic acid according to the applicable product information, including:

   • active arterial or venous thromboembolic disease or active intravascular clotting;
   • history of subarachnoid hemorrhage;
   • acquired defective color vision;
   • clinically relevant seizure disorder or previous tranexamic-acid-associated seizure;
   • disseminated intravascular coagulation without predominant hyperfibrinolysis;
   • active upper urinary tract hematuria with a risk of ureteric obstruction.
5. Renal function incompatible with the fixed protocol dose, including estimated glomerular filtration rate below 30 mL/min/1.73 m² or dialysis.
6. Contraindication to either administration route, including inability to swallow tablets, malabsorption precluding oral dosing, or inability to obtain intravenous access.
7. Pregnancy or breastfeeding.
8. Participation in another interventional clinical trial that could interfere with study outcomes or safety.
9. Planned use of another antifibrinolytic agent outside the protocol, including aprotinin or epsilon-aminocaproic acid.
10. Any new clinical condition identified after randomization but before dosing that, in the investigator's judgment, makes administration of the study treatment unsafe.
11. Uncontrolled hemodynamic or respiratory instability before administration of the study intervention.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Oral Tranexamic Acid; Participants receive 2 g of oral tranexamic acid as four 500 mg tablets approximately 2 hours before surgical incision, together with an intravenous placebo administered at induction or incision according to the study protocol.	Drug: Oral tranexamic acid; Tranexamic acid, 2 g orally, administered as four 500 mg tablets approximately 2 hours before surgical incision.; Drug: Intravenous placebo; Intravenous placebo consisting of 50 mL of 0.9% sodium chloride, administered at induction or incision according to the study protocol.
Active Comparator: Intravenous Tranexamic Acid; Participants receive four matching oral placebo tablets approximately 2 hours before surgical incision, together with 1 g of intravenous tranexamic acid administered at induction or incision according to the study protocol.	Drug: Exacyl®; Tranexamic acid, 1 g intravenously, diluted in 0.9% sodium chloride to a total volume of 50 mL and administered at induction or incision according to the study protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulative Chest Tube Blood Loss Within 24 Hours After Surgery (mL)	Total cumulative volume of blood collected from mediastinal and pleural chest drains during the first 24 hours after completion of surgery, expressed in milliliters.	From completion of surgery to 24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Receiving Red Blood Cell Transfusion	Number and proportion of participants receiving at least one unit of packed red blood cells during surgery or the postoperative hospital stay, and the total number of units transfused per participant.	From surgery until hospital discharge, up to 30 days
Hemoglobin Concentration at 24 Hours After Surgery (g/dL)	Hemoglobin concentration measured from routine postoperative blood samples, expressed in grams per deciliter.	At 24 hours after surgery
Number of Participants Requiring Reoperation for Bleeding	Number and proportion of participants requiring surgical re-exploration because of postoperative bleeding or cardiac tamponade.	During the index hospitalization, up to 30 days
Number of Participants With Thromboembolic Events	Occurrence of clinically diagnosed arterial or venous thromboembolic events, including myocardial infarction, ischemic stroke, deep vein thrombosis, or pulmonary embolism.	From study intervention until 30 days after surgery
Number of Participants With Postoperative Seizures	Occurrence of clinically diagnosed postoperative seizures.	During the index hospitalization, up to 30 days
Number of Participants With Acute Kidney Injury According to Kidney Disease: Improving Global Outcomes (KDIGO) Criteria	Number of participants with postoperative acute kidney injury classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria (Stages 1, 2, or 3).	Within 7 days after surgery or until hospital discharge, whichever occurs first
Number of Participants With All-Cause Mortality Within 30 Days After Surgery	Death from any cause.	Within 30 days after surgery
Length of Intensive Care Unit Stay (days)	Duration of the postoperative intensive care unit stay, expressed in hours or days.	From intensive care unit admission until discharge from the intensive care unit, up to 30 days
Length of Hospital Stay (days)	Duration of the postoperative hospital stay, expressed in days.	From the date of surgery until hospital discharge, up to 30 days

Collaborators and Investigators

• Sponsor: Clinique Saint-Luc
• Investigators: Principal Investigator: Benjamin Javillier, MD, Clinique Saint-Luc Bouge

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): July 1, 2028

Study Registration Dates

• First Submitted: July 28, 2026
• First Submitted That Met QC Criteria: July 30, 2026
• First Posted (Actual): July 31, 2026

Study Record Updates

• Last Update Posted (Actual): July 31, 2026
• Last Update Submitted That Met QC Criteria: July 30, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Cardiac Surgery; Intravenous Administration; Oral Administration; Tranexamic Acid; OPCAB; Non-Inferiority Trial; Postoperative Blood Loss; Off-Pump Coronary Artery Bypass Grafting
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Postoperative Complications; Pathologic Processes; Heart Diseases; Hemorrhage; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Myocardial Ischemia; Pathological Conditions, Signs and Symptoms; Coronary Artery Disease; Postoperative Hemorrhage; Organic Chemicals; Carboxylic Acids; Acids, Carbocyclic; Cyclohexanecarboxylic Acids; Tranexamic Acid
• Other Study ID Numbers: TRANSCAB; 2026-526581-24-01 (Ctis)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the published results may be made available to qualified researchers upon reasonable request. Requests will be reviewed by the Sponsor and Coordinating Investigator and will require an approved research proposal and a signed data use or data transfer agreement. Data sharing will be subject to applicable ethical, legal, regulatory, and data-protection requirements.
• IPD Sharing Time Frame: Beginning 12 months after publication of the primary results and available for 5 years.
• IPD Sharing Access Criteria: Access may be granted to qualified researchers whose proposed use of the data has been approved by the Sponsor. Requests must include a scientifically sound research proposal and will require a signed data use or data transfer agreement. Data will be shared only in accordance with applicable data-protection, ethical, and regulatory requirements.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No