Panos Kougias, MD, MSc, FACS, and Sherene Sharath, PhD, MPH Publish Landmark TOP Trial in JAMA
Nov 30, 2025
We are incredibly proud to announce that our Chair, Panos Kougias, MD, MSc, FACS, and Director of Clinical and Health Services Research, Sherene Sharath, PhD, MPH, have published a landmark original investigation in the Journal of the American
Medical Association (JAMA). Their study, titled "Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk:
The TOP Randomized Clinical Trial," addresses a critical dilemma in perioperative care regarding how to safely manage
transfusion thresholds for high cardiac risk patients undergoing major vascular or
general surgery.
The trial was conducted across 16 Veterans Affairs Medical Centers and enrolled 1,428 veterans to compare outcomes between a liberal transfusion strategy (triggered at <10 g/dL) and a restrictive one (triggered at <7 g/dL). While there was no significant difference in the primary composite endpoint of mortality, stroke, acute kidney failure, coronary revascularization, and myocardial infarction at 90 days, the secondary outcomes offered a crucial insight. Notably, the liberal strategy significantly reduced the risk of other cardiac complications, such as arrhythmias and heart failure, by nearly half (5.9% vs. 9.9%).
This high-impact publication adds vital data to the discussion of transfusion management in patients with high cardiac risk. It suggests that while a liberal strategy may not reduce overall mortality, it might offer specific protective benefits against cardiac complications in this vulnerable surgical population. Please join us in congratulating Dr. Kougias and Dr. Sharath on this significant contribution to surgical science and for representing Downstate Surgery on the national stage. The study was featured in numerous news reports including our very own President’s Bulletin.