NHSBT has welcomed new NICE draft guidance proposing wider use of tranexamic acid

20 November 2025

NHSBT has welcomed new NICE draft guidance proposing wider use of tranexamic acid (TXA) to reduce the need for blood transfusions.

TXA is a medicine that controls bleeding 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, implementation of the recommendation has been inconsistent: a 2024 national audit found that one in four eligible patients were not given TXA.

Now, new evidence shows tranexamic acid is safe and clinically and cost-effective even for patients expected to lose smaller amounts of blood.

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

Instead of having to estimate how much blood a patient is expected to lose, the new 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 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 annually.

The draft updated NICE guideline on blood transfusion is available to view on the NICE website.

Lise Estcourt, Medical Director of Transfusion at NHS Blood and Transplant, said:

"We welcome this draft NICE guidance on the wider use of tranexamic acid, 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promote the use of tranexamic acid through our Patient Blood Management team and we ask hospitals to support this new draft guidance.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."