Qurexa Logo
Qurexa

Trust. Care. Deliver.

Back to Blog & Insights
Health

A simple change to surgery guidance could mean fewer blood transfusions

Qurexa Editorial Team4 September 20266 min read 0 0
A simple change to surgery guidance could mean fewer blood transfusions

What happened

In early September 2026, the National Institute for Health and Care Excellence updated its guideline on blood transfusion. The guideline is known as NG24. The National Blood Transfusion Committee announced the change on 3 September 2026. NICE is the body that looks at evidence and then advises the NHS on what good care looks like. Its guidelines are not laws, but hospitals across England pay close attention to them. The update is about a medicine called tranexamic acid, often shortened to TXA. Tranexamic acid helps blood clots hold together. It does not create clots from nothing. It stops the clots your body already makes from breaking down too quickly. That means less bleeding during and after an operation. The change itself sounds small, but it removes a real obstacle. The old approach asked surgical teams to judge whether a patient was likely to lose a certain amount of blood before giving TXA. Estimating blood loss before an operation is genuinely difficult, even for experienced clinicians. The updated guidance drops that step for operations in a theatre. NICE now advises offering tranexamic acid to adults having surgery in an operating theatre if there is any risk of bleeding and the procedure will breach the skin or mucous membranes. For surgery outside an operating theatre, such as in interventional radiology or A&E, the guidance still uses a threshold. There, TXA is offered to adults expected to lose more than 500 millilitres of blood.

Why this matters

Blood is a donated resource. Every unit given to one person is a unit that came from a volunteer and cannot be given to somebody else. Reducing avoidable transfusions helps keep supplies steady for the people who genuinely cannot manage without them. Transfusions are also not risk-free. They are safe and well managed in the UK, but like any medical treatment they carry a small chance of a reaction. Avoiding a transfusion that was never needed is better for the patient as well as the blood supply. There is a practical angle too. Less bleeding during an operation can mean a smoother recovery. It can mean fewer complications and, in some cases, a shorter stay in hospital. The wider point is about how guidance is written. If a recommendation depends on a judgement that is hard to make reliably, it will be applied unevenly. Some patients will get the medicine and others in the same situation will not. Simplifying the rule makes it more likely that similar patients receive similar care, wherever they are treated. That is a quieter kind of improvement than a new drug or a new machine. It rarely makes headlines. But changes that make good practice easier to follow can reach a very large number of people.

What the evidence actually says

Tranexamic acid is not new. It has been used for decades, and it is one of the better-studied medicines in surgery and emergency care. That long history is part of why NICE was able to widen its use with reasonable confidence. The updated NICE recommendations set out some specific practical detail. TXA should be given just before the start of surgery. The typical dose described is 1 gram by slow injection into a vein. NICE also addresses repeat doses. It notes that more than one dose might be helpful if surgery goes on for a long time or if there is a lot of blood loss. But it asks clinicians to weigh that against the risks of extra doses. One risk it names specifically is tranexamic acid building up in the blood in people whose kidneys are not working well. That balance is worth noticing. This is not guidance saying that more is always better. It is guidance saying the medicine should be available more consistently at the start, while still asking for careful judgement afterwards. It is also worth being clear about what this update does not say. It does not mean everyone having any procedure will now be given tranexamic acid automatically. The recommendation is about surgery where there is a risk of bleeding and the skin or mucous membranes are breached. Your surgical team will still consider your own medical history, including any clotting disorders, kidney problems or medicines you already take. And guidance is guidance. Clinicians can depart from it when there is a good reason for an individual patient. That flexibility is deliberate.

Practical advice

If you or someone close to you has an operation coming up, here are some sensible things to do. Bring an up-to-date list of your medicines to your pre-operative appointment. Include anything you buy without a prescription, plus vitamins and herbal supplements. Blood-thinning medicines matter a great deal here, but so do things people often forget to mention. Mention any history of blood clots, strokes, or clotting problems in your family. This is directly relevant to decisions about medicines like tranexamic acid. Tell the team about kidney problems. NICE specifically flags reduced kidney function as something that affects repeat dosing. It is completely reasonable to ask what is being done to reduce bleeding during your operation. Most surgical teams are happy to explain. Asking a question is not questioning their competence. If you are anaemic, say so. Low iron before surgery is common and often treatable in the weeks beforehand, which can reduce the chance of needing a transfusion. Follow the fasting and medication instructions you are given exactly. If you are unsure whether to take a regular medicine on the morning of surgery, ring the pre-operative assessment team rather than guessing. After the operation, keep taking your prescribed medicines as directed and go to your follow-up appointments.

What to know

NICE has updated guideline NG24 on blood transfusion, with the change announced in early September 2026. For adults having surgery in an operating theatre, tranexamic acid is now recommended where there is any risk of bleeding and the procedure breaches the skin or mucous membranes. Surgical teams no longer need to estimate expected blood loss first. For surgery outside a theatre, such as interventional radiology or A&E, the recommendation applies where more than 500 millilitres of blood loss is expected. The typical approach described is 1 gram given slowly into a vein just before surgery starts, with careful thought before any repeat doses, particularly for people with reduced kidney function. The aim is fewer avoidable transfusions and more consistent care. If you have an operation planned, your surgical team can explain what this means for you. Sources: National Blood Transfusion Committee, 'Updated NICE Guidance on Tranexamic Acid (TXA)', 3 September 2026, https://nationalbloodtransfusion.co.uk/news/2026/updated-nice-guidance-tranexamic-acid-txa | National Institute for Health and Care Excellence, 'Blood transfusion (NG24): Recommendations', https://www.nice.org.uk/guidance/ng24/chapter/recommendations | Centre for Perioperative Care, 'NICE guideline publication: NG24 Blood transfusion: tranexamic acid', https://cpoc.org.uk/nice-guideline-publication-ng24-blood-transfusion-tranexamic-acid This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional. Decisions about medicines before, during and after surgery should be made with your own clinical team, who know your medical history.

#NICE#surgery#blood transfusion#tranexamic acid#NHS#patient safety

Related articles