Just one thing to reduce bleeding: Put tranexamic acid on the safe surgical checklist at your hospital

To highlight tranexamic acid (TXA) as 'just one thing' that every hospital could implement to reduce surgical bleeding and blood transfusions.

TXA is a low-cost antifibrinolytic agent that inhibits the breakdown of fibrin blood clots. Developed in Japan in the 1960s, it has been shown to reduce surgical bleeding. TXA is also effective in traumatic and postpartum haemorrhage, with no proven increase in thrombosis.

Evidence from clinical trials, national guidelines, and policy reports was reviewed, including NICE recommendations and the UK Infected Blood Inquiry report. Patterns of TXA use and barriers to implementation were examined.

There is strong evidence for the safety and effectiveness of TXA in surgery. However, despite inclusion in NICE guidelines since 2016, approximately one quarter of eligible surgical patients in the UK do not receive TXA, with similar underuse reported internationally. This results in missed opportunities to improve patient outcomes and reduce costs. The UK Infected Blood Inquiry recommended inclusion of TXA on surgical checklists, supported by regular audit and reporting.

TXA represents an effective intervention to improve surgical outcomes and reduce transfusion. Increased uptake requires stronger leadership, audit systems, training, patient advocacy and alignment of clinical incentives with evidence-based practice.