Tranexamic acid

bleeding massive transfusion tranexamic acid Feb 26, 2026

The drug we can’t afford to  forget

Bleeding risk is part of many surgical journeys. As perianaesthesia nurses, we sit close to that tipping point between stable and unstable. Tranexamic acid, or TXA, is one of the tools that can quietly shift outcomes in our patients’ favour when bleeding is anticipated or underway.

Tranexamic acid is an antifibrinolytic. It works by blocking the binding of plasminogen to fibrin, slowing the breakdown of clots. In simple terms, it helps the body hold onto the clots it has already formed. It does not create new clots. It protects what is there. In noncardiac surgery, evidence shows TXA reduces bleeding and transfusion requirements without a clear increase in major thrombotic events when used appropriately. Recent literature continues to support its role across a range of surgical settings, with attention to patient selection and dosing.

🩸 TXA reduces surgical blood loss and need for transfusion
🩸 It stabilises formed clots by limiting fibrinolysis
🩸 Early administration is generally more effective than delayed dosing
🩸 Patient assessment remains essential, particularly in those with thrombotic risk

For perianaesthesia nurses, this means understanding why TXA has been given, when it should be administered, and what to monitor. Timing matters. So does communication. Clarify the indication, check dosing, observe for bleeding trends, and remain alert to neurological changes or thrombotic concerns.

Tranexamic acid is not a substitute for surgical haemostasis or comprehensive blood management. It is one component of a coordinated approach. Knowing how it works builds confidence. Using it thoughtfully supports safer surgical recovery.

References

Devereaux, P.J., et al. (2022). Tranexamic Acid in Patients Undergoing Noncardiac Surgery.
Frontiers in Medicine. (2024). Tranexamic acid and perioperative outcomes in surgical patients.

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