NHSBT amber alert and the use of tranexamic acid in surgery

Tuesday 18 October - Additional guidance has now been issued on the use of tranexamic acid in surgery, please see our update.

NHS Blood and Transplant (NHSBT) triggered an ‘amber alert’ on 12 October, meaning hospitals have been asked to put in place management plans to protect blood stocks.

In line with these measures requested by NHSBT, we recommend that use of tranexamic acid is considered in all adult surgical patients and administered if more than 500ml of blood loss is likely. We also recommend that theatre teams consider adding this prompt to the perioperative care theatre checklist process.

Results from the recent POISE-3 clinical trial confirm the quality, safety and cost-effectiveness of using tranexamic acid in moderate surgery, where more than 500ml of blood loss is anticipated. This evidence further supports the NICE quality statement on blood transfusion and complements the recent Centre for Perioperative Care guideline ‘Anaemia in the Perioperative Pathway’.

Increasing the use of tranexamic acid in this way may reduce the risk of cancelling elective surgery due to limited availability of blood stocks.

Please share this with your colleagues, especially those in your perioperative, surgical and anaesthetic departments.

Join our webinar at 6pm on 21 November to hear Professor Neil Mortensen, President of RCS England, and other leading surgeons share important information about the use of Tranexamic acid. The webinar will feature a live Q&A.

Resources:

• A plan for NHS Blood and Transplant and Hospitals to address red cell shortages (July 2022)
• Checklist: Emergency Blood Management Arrangements (EMBA)

References

• NHSBT (2022). Amber alert issued on blood stocks. https://www.blood.co.uk/news-and-campaigns/news-and-statements/amber-alert-issued-on-blood-stocks-existing-o-neg-and-o-pos-donors-asked-to-make-appointments/
• Marcucci, M., Painter, T.W., Conen, D. et al. Rationale and design of the PeriOperative ISchemic Evaluation-3 (POISE-3): a randomized controlled trial evaluating tranexamic acid and a strategy to minimize hypotension in noncardiac surgery. Trials 23, 101 (2022). https://doi.org/10.1186/s13063-021-05992-1
• NICE (2016). Quality statement 2: Tranexamic acid for adults. Blood transfusion Quality Standard [QS138]. https://www.nice.org.uk/guidance/qs138/chapter/Quality-statement-2-Tranexamic-acid-for-adults
• Centre for Perioperative Care (2022). Guideline for the Management of Anaemia in the Perioperative Pathway. https://cpoc.org.uk/guidelines-resources-guidelines/anaemia-perioperative-pathway
• UK Royal Colleges Tranexamic Acid in Surgery Implementation Group, Grocott MPW, Murphy M, Roberts I, Sayers R, Toh CH. Tranexamic acid for safer surgery: the time is now. Br J Surg. 2022 Sep 5:znac252. https://doi.org/10.1093/bjs/znac252