PeriOperative ISchemic Evaluation-3 Trial

Inclusion criteria:

1. Undergoing noncardiac surgery;

2. ≥ 45 years of age;

3. Expected to require at least an overnight hospital admission after surgery;

4. Provide written informed consent to participate in the POISE-3 Trial, AND

5. Fulfill ≥1 of the following 6 criteria (A-F):

A. NT-proBNP ≥200 ng/L B. History of coronary artery disease C. History of peripheral arterial disease D. History of stroke E. Undergoing major vascular surgery; OR F. Any 3 of 9 risk criteria i. Undergoing major surgery; ii. History of congestive heart failure; iii. History of a transient ischemic attack; iv. Diabetes and currently taking an oral hypoglycemic agent or insulin; v. Age >70 years; vi. History of hypertension; vii. Serum creatinine > 175 µmol/L (> 2.0 mg/dl); viii. History of smoking within 2 years of surgery; ix. Undergoing emergent/urgent surgery.

Exclusion criteria:

1. Patients undergoing cardiac surgery

2. Patients undergoing cranial neurosurgery

3. Planned use of systemic TXA during surgery

4. Low-risk surgical procedure (based on individual physician's judgment)

5. Hypersensitivity or known allergy to TXA

6. Creatinine clearance <30 mL/min (Cockcroft-Gault equation) or on chronic dialysis

7. History of seizure disorder

8. Patients with recent stroke, myocardial infarction, acute arterial thrombosis orvenous thromboembolism (<3 month)

9. Patients with fibrinolytic conditions following consumption coagulopathy

10. Patients with subarachnoid hemorrhage within the past 30 days

11. Women of childbearing potential who are not taking effective contraception, pregnantor breast-feeding

12. Previously enrolled in POISE-3 Trial