AuscandocWider use of tranexamic acid to reduce surgical bleeding could benefit patients and health systems
Ian Roberts and colleagues call for greater use of this inexpensive generic drug that can improve surgical outcomes, avoid unnecessary blood transfusion, and conserve blood stocks Major bleeding during surgery is common and is an important cause of surgical deaths.1 Each year, worldwide, over 300 million people have major surgery, and around four million die within 30 days of the operation.2 In the UK, there are eight million surgical procedures each year with about 85 000 deaths within 30 days.3 Major bleeding is strongly associated with mortality, accounting for the largest share of deaths.1 Transfusion can be lifesaving, but blood is a scarce resource and transfusion has risks. The strong evidence that tranexamic acid safely reduces surgical bleeding and the need for blood transfusion therefore has important implications for patient care, not only in the UK but worldwide. In the UK the National Institute for Health and Care Excellence (NICE) made the use of tranexamic acid for adults who are having surgery and expected to have “moderate (>500 ml) blood loss” a quality standard in 2016.4 However, according to a 2023 NHS national comparative audit, at least one third of surgical patients in England who should receive tranexamic acid are not treated.5 We estimate that half a million surgical patients in the UK miss out on the benefits of tranexamic acid. Full compliance with the NICE quality standard would prevent about 15 000 major surgical bleeds, avoid the transfusion of 33 000 units of blood, and save 45 000 hospital days and millions of pounds for the NHS each year.6 High rates of non-use of tranexamic acid have also been found in Australia and New Zealand.7 Clinical audit also shows a wide variation in tranexamic acid use by different surgical specialties.5 Tranexamic acid is most …
Michiel De Smet
Phys.org
Black Flag Medical