Tranexamic Acid - Scotland, Wales and NI

In Northern Ireland, the Department of Health is currently liaising with Health Trusts, Royal College of Surgeons, Northern Ireland Blood Transfusion Service (NIBTS) and Northern Ireland Transfusion Committee (NITC) to understand the extent to which the use of tranexamic acid is used or offered across the system. The NITC, in particular, has asked all Trusts to ensure tranexamic acid is being offered to patients receiving relevant surgery and have engaged with each Trust’s Transfusion Committee to reconcile the necessary assurance that current practices do indeed meet the requirements of this recommendation.

The Welsh Government has asked the Blood Health National Oversight Group (BHNOG) to work with our Health Boards and Trusts to confirm adherence to the current NICE guidance. The BHNOG will then review the findings and propose improvements as necessary. A WHC has been issued to support this recommendation including support from the Chief Pharmaceutical Officer on dosing guidance ahead of the anniversary of the publication of the IBI report. Longer term projects on data through eMPA (e-Prescribing and Medicines Administration System) and development of an All Wales Surgical Checklist to include Patient Blood management – such a use of TXA. As these are national programmes of work expected implementation will need to be phased therefore rolling completion is expected by 2026.

The Scottish Government’s Oversight and Assurance Group (OAG) Chair and Deputy Chair wrote to Health Boards in November 2024 asking them to review practice within their Board and confirm that they are offering tranexamic acid to patients wherever it is appropriate for them in advance of elective surgery. This letter also asked Health Boards to use the Scottish National Blood Transfusion Service’s (SNBTS) Clinical Transfusion Dashboard to consider areas for improvement to ensure they are only providing transfusions where this is necessary in line with recommendation 7a) iii. Health Boards were supportive in their responses, although some raised questions about the full and updated evidence base for use of tranexamic acid in some cases/particular surgeries so it is clear some additional guidance is needed on what should be considered ‘eligible surgery’ (as this was not specified by the Inquiry). There is general consensus that tranexamic acid should be used in advance of operations where blood loss of over 500ml is likely to occur. However, given ongoing discussions at UK level and an anticipated request to NICE to update its guidance, the Scottish Government will provide a further update to Health Boards on these matters once updated clinical guidance is available. All Health Boards have confirmed that the SNBTS Clinical Transfusion dashboard is being utilised to benchmark and improve transfusion practice.

In relation to recommendation 7a(ii), Lorna advised that revised National Institute for Health and Care Excellence guidance to broaden the use and scope of tranexamic acid was issued in February 2026. This revised guidance has been tabled for information at SNBTC with the plan for Chairs of the hospital transfusion committees (HTCs) to share the information and make sure there is broad awareness in Boards. SNBTS Transfusion Practioners have also disseminated this to hospital transfusion teams and HTCs. The OAG confirmed it was content with this approach.