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VA Cooperative Studies Program (CSP)

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CSP #599: Transfusion Trigger After Operations in High Cardiac Risk Patients (TOP)


Investigator Access

What's Available

Check with the study contact and publications for information on a public dataset, data archive, data enclave, or website where data might be available.

Available Documentation

Dates Data are Available

Access Criteria

Study Characteristics


To determine whether a liberal transfusion strategy (transfusion trigger at Hb < 10 gm/dl) in Veterans at high cardiac risk who undergo major open vascular and general surgery operations is associated with decreased risk of adverse postoperative outcomes compared to a restrictive transfusion strategy (transfusion trigger at Hb < 7 gm/dl).

Era of Service



Inclusion Criteria

  • Males and females older than 18 years of age who have postoperative Hb < 10 gm/dl within 15 days after the index operation
  • Patients who undergo an operation in either one of the three following categories, regardless of their preoperative Hb level, and regardless of preoperative or intraoperative transfusion they might have received:
       o  Veterans who undergo peripheral artery disease (PAD)-related operations
       o  Veterans with past medical history of ischemic stroke or ischemic heart disease (IHD) or PAD who undergo general surgery procedures
       o  Veterans with past medical history of ischemic stroke or IHD or PAD who undergo Vascular Surgery operations

Exclusion Criteria

  • Unable to consent or unwilling to follow protocol, such as Jehovah’s witnesses
  • Known history of hereditary anemias such as Thalassemia or Sickle cell disease; known history of hereditary bleeding disorders, such as factor VIII or factor IX deficiency; or prior history of adverse reaction to blood administration, such as fever, rash, or hemolysis
  • Doesn’t speak or understand English
  • Hemodynamically unstable or in cardiogenic shock
  • Participating in another interventional trial whose objective is to evaluate the effect of transfusion on outcomes, or prior randomization in CSP #599
  • Pregnancy 
  • Prisoner or in custody of law enforcement

Study Design

Randomized, intent-to-treat, two-arm, parallel design, single-blind, multicenter trial

Time Period

2018 – 2022


National (15 VA Medical Centers)


3,070 participants

Response Rate

Recruitment ongoing

Recruitment Method




Data Collected

  • Length of hospital stay
  • All-cause mortality at 1 year after randomization (myocardial infarction (MI), coronary revascularization, acute renal failure, or postoperative ischemic stroke)
  • A composite endpoint (up to 90 days after randomization) of:     
       o  All-cause post-randomization mortality
       o  MI
       o  Coronary revascularization
       o  Acute renal failure
       o  Post-randomization ischemic stroke
       o  New cardiac arrhythmias that necessitate new treatment
       o  New or worsening congestive heart failure (CHF)
       o  Cardiac arrest

Data Collection Methods

  • Assessments will be collected pre/post-operatively and at discharge, or at 30 days after randomization if the patient is still hospitalized
  • Follow up forms will be filled out during a clinic visit after the 30th and 90th post-randomization day. Patients who cannot present to the clinic will have a phone call for follow up
  • One year post-randomization mortality will be ascertained using electronic medical records, phone follow-up, and search of the national death index

Funding Source

VA Cooperative Studies Program (CSP)


Erin Norman,

Selected Publications


More Information Identifier: NCT03229941 1

1 This link takes you to a non-U.S. government website. VA isn't responsible for the content or privacy policies on that site and doesn't endorse the content or its sponsor.