Tranexamic acid use: recommendation 7a of the Infected Blood Inquiry (IBI) (WHC/2025/017)

Status:

Action.

Category:

Policy.

Title:

Tranexamic acid use: recommendation 7a of the Infected Blood Inquiry (IBI).

Date of expiry / review:

Not applicable.

For action by:

NHS health boards and trusts, and primary care providers.

Required by:

Immediate.

Senders:

• Professor Pushpinder Mangat, Deputy Chief Medical Officer, Health Services.
• Andrew Evans, Chief Pharmaceutical Officer.

Welsh Government contacts:

Tom Warren
Quality and Safety
Quality and Nursing Directorate.

Telephone: 03000 258 109

Email: QualityAndNursing@gov.wales

Dear Colleagues,

Following the publication of the infected blood inquiry and its recommendations on 20 May 2024, I have been chairing an oversight group to monitor the implementation of the recommendations.

Today I am writing in relation to the recommendation 7 "patient safety: blood transfusions" and specifically recommendation 7a tranexamic acid use.

The full report can be accessed at the infected blood inquiry’s website.

Recommendation 7 patient safety: blood transfusions

(a) Tranexamic acid (TXA)

(ii) In Scotland, Wales and Northern Ireland offering the use of TXA should be considered a treatment of preference in respect of all eligible surgery.

To support this, I would be grateful if the following were endorsed and actioned within local health boards and NHS trusts:

• implementation of the use of tranexamic acid in line with guidance issued from the Joint Royal Colleges Tranexamic Acid in Surgery implementation group and NICE quality standard QS138
• tranexamic acid should be included on surgical checklists

(iii) Consideration be given to standardising and benchmarking transfusion performance between hospitals in order to deliver better patient blood management.

Although not explicitly mentioned within the IBI recommendations, I wish to highlight that use of TXA to prevent blood loss is one element of patient blood management (PBM) and there should be consideration of the breadth of PBM to further enhance patient safety related to blood transfusion particularly within the surgical setting.

To support this, I would be grateful if the following were endorsed and actioned within local health boards and NHS trusts:

• continue to support implementation of the NHS Wales Preoperative Anaemia Pathway
• include intraoperative cell salvage (ICS) on surgical checklists

I would be grateful if you could confirm the action you have taken by copying the relevant messaging to the qualityandnursing@gov.wales by 4 June 2025.

Yours sincerely,

Professor Pushpinder Mangat.
Deputy Chief Medical Officer, Health Services.

Andrew Evans OBE.
Chief Pharmaceutical Officer.