Quality statement 2: Tranexamic acid for adults having surgery in an operating theatre
Quality statement
Adults who are having surgery in an operating theatre where there is any risk of bleeding and the procedure will breach the skin or mucous membrane receive tranexamic acid.
Rationale
Tranexamic acid can reduce the need for blood transfusion in adults having surgery. This avoids serious risks associated with blood transfusion, for example infection, fluid overload and incorrect blood transfusions being given. It may also reduce the length of hospital stays and the cost to the NHS.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of adults who are having surgery in an operating theatre where there is a risk of bleeding and the procedure will breach the skin or mucous membrane who receive tranexamic acid.
Numerator – the number in the denominator who receive tranexamic acid.
Denominator – the number of adults who are having surgery in an operating theatre where there is any risk of bleeding and the procedure will breach the skin or mucous membrane.
Data source: NHS Blood and Transplant national comparative audit of NICE quality standard QS138 currently audits the proportion of adults having surgery with expected moderate blood loss and is being updated to reflect the updated measure.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that systems are in place to give tranexamic acid to adults who are having surgery in an operating theatre where there is any risk of bleeding and the procedure will breach the skin or mucous membrane.
Healthcare professionals (such as doctors, nurses and blood transfusion specialists) give tranexamic acid to adults who are having surgery in an operating theatre where there is any risk of bleeding and the procedure will breach the skin or mucous membrane. They should make decisions on the use of tranexamic acid for individual cases based on the full clinical picture.
Commissioners ensure that tranexamic acid is available to adults who are having surgery in an operating theatre where there is any risk of bleeding and the procedure will breach the skin or mucous membrane.
Adults who are having a surgery in an operating theatre where they may bleed or where their operation will breach the skin or mucous membrane are offered tranexamic acid. This helps blood to clot better and reduces blood loss during surgery.
Source guidance
Blood transfusion. NICE guideline NG24 (2015, updated 2026), recommendation 1.1.5
Definitions of terms used in this quality statement
Adults
People aged 18 years and over. This statement will generally apply to young people (aged 16 and 17 years) as well, but healthcare professionals should use their clinical judgement on when this is not appropriate for individual patients. [NICE's guideline on blood transfusion, terms used in this guideline]