Surgical Bleeding

Every year there are over 300 million surgical procedures worldwide

Bleeding is an important complication and many patients require a blood transfusion

Research Overview

TXA for Surgical Bleeding

About one-third of transfused blood in the UK is used for surgical patients who receive an average of two units. 

However, blood for transfusion is a scarce and costly resource – most people in the world do not have access to donor blood, and blood transfusion is not without risk.

TXA has been used for many years in surgery and there is good evidence from randomised controlled trials that it reduces surgical bleeding.

A systematic review identified 129 trials including 10,488 patients. 

The results showed that TXA reduces the probability of receiving a blood transfusion by 38% (relative risk =0.62, 95% ci 0.58 to 0.65; p<0.001) and blood loss by 34% (proportional ratio=0.6695% CI 0.65 to 0.67; p<0.001).

These effects were seen across different surgical procedures and remained large when the analysis was restricted to trials with good allocation concealment.

TXA reduces blood loss in surgical patients by about one‐third. A total dose of 1 g appears to be sufficient for most adult surgical patients.

However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain.

Although there were fewer deaths and myocardial infarctions in the TXA group, the pooled estimates were imprecise, and because many trials did not report data for these outcomes, there is the potential for bias due to selective reporting.

The uncertainty concerning the effect on thromboembolic events is an important factor limiting the uptake of TXA since an increase in thrombosis could outweigh the benefits of reduced blood use.

More Resources

Click on watch, read or teach to access videos, publications, and training materials 

 

TXA Surgical Bleeding: Systematic Review 1

Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis
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TXA Surgical Bleeding: Systematic Review 2

Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss
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TXA Surgical Bleeding: Systematic Review 3

Exploring redundant research into the effect of tranexamic acid on surgical bleeding: further analysis of a systematic review of randomised controlled trials
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TXA Surgical Bleeding: Economics

Giving tranexamic acid to reduce surgical bleeding in sub-Saharan Africa: an economic evaluation
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TXA Surgical Bleeding: Avoidable Mortality

Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial
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Tranexamic Acid and Surgical Bleeding

Presentation summarising the evidence for the use of TXA in surgery
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More Treatments

TXAcentral is a resource for health professionals caring for people with acute bleeding
TXAcentral brings together randomised trial evidence on the effectiveness and safety of tranexamic acid
Data on many of the trials are also available at the freeBIRD website

In trauma patients with significant bleeding and those with traumatic brain injury (TBI), TXA has been  shown to reduce mortality in both extracranial and intracranial bleeding

Postpartum Haemorrhage (PPH) is the leading cause of maternal death worldwide, responsible for around 100 000 deaths each year. TXA given as quickly as possible after birth and no later than 3 hours, reduces death due to bleeding and the need for surgery to stop bleeding

GI Bleeding is a common emergency that causes substantial mortality and morbidity worldwide. TXA was found to not reduce deaths from GI bleeding and showed an increased risk of thromboembolic events

Every year there are over 300 million surgical procedures worldwide. Bleeding is an important complication and many patients require a blood transfusion. TXA reduces blood loss in surgical patients by about one‐third. However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain

There is ongoing research looking at how Tranexamic Acid (TXA) could be utilised for other bleeding conditions