NICE draft guidance proposing wider use of tranexamic acid (TXA) to reduce the need for blood transfusions and improve patient care

TXA is a medicine that helps to control bleeding during surgery by preventing the breakdown of clots. It helps the body keep the clots it naturally forms, so there is less bleeding. 

NICE’s current guidance on blood transfusion, introduced in 2015, recommends TXA for adults expected to lose more than 500ml of blood during surgery. However, implementing the recommendation has been inconsistent: a 2024 national audit found that one in four eligible patients were not given TXA. 

New evidence shows TXA is clinically safe and cost-effective even for patients expected to lose smaller amounts of blood. It also extends the recommendation to include children as well as adults undergoing surgery. 

NICE’s updated recommendations have been published for public consultation. They redraw the line between those people having surgery who should get TXA and those who should not, simplifying decision-making for clinicians. 

Instead of having to estimate how much blood a patient is expected to lose, the draft recommendations say TXA should be offered if all the following conditions are met:

• surgery is being performed in an operating theatre
• there is a risk of bleeding
• the procedure will breach the skin or mucous membrane

The updated guidance also advises considering TXA in children using the same criteria. 

In 2024, leading doctors writing in the British Medical Journal (BMJ) estimated that full implementation of NICE’s 2015 guidance could prevent 15,000 major surgical bleeds, avoid 33,000 blood transfusions, save 45,000 hospital days, and reduce NHS costs by millions of pounds annually.

Read the updated draft guidance

We welcome this draft NICE guidance on the wider use of TXA which has been shown to reduce the need for transfusions. Blood saves lives but every transfusion carries a risk, and a blood transfusion is often not the best option. The safest transfusion is often no transfusion.

We promote the use of TXA through our patient blood management (PBM) team, and we ask hospitals to support this new draft guidance. As well as providing better patient care, reducing unnecessary blood use also helps us protect blood stocks.

The use of TXA is a major clinical campaign point for NHS Blood and Transplant (NHSBT) over the Amber alert, hospital blood use, and the Infected Blood Inquiry (IBI).

Lise Estcourt - Medical Director for Transfusion, NHSBT