Tranexamic acid in reducing expected blood loss in moderate to low risk surgeries: systematic review, meta-analysis and cost effectiveness analysis Article Swipe
Nishant Jaiswal
,
Giorgio Ciminata
,
William A. Robinson
,
Martin Taylor‐Rowan
,
Tom Morris
,
Clareece R. Nevill
,
Hasan Tahir
,
Elizabeth Fisher
,
Ryan J. Mulholland
,
Michael D. Lumsden
,
Anna H Noel-Storr
,
Andrew Davies
,
Nicola J. Cooper
,
Terence J. Quinn
,
Alex J. Sutton
,
Olívia Wu
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1101/2025.07.21.25331903
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1101/2025.07.21.25331903
Tranexamic acid (TXA) is well-established as a safe intervention for reducing transfusion requirements in surgeries with high-risk for blood loss. However, its role in surgeries classified as low-risk for blood loss remains uncertain. Given the frequency of such procedures, even small clinical benefits could have substantial cumulative impact. We assessed the clinical and cost-effectiveness of TXA in surgeries with low expected blood loss A systematic review and meta-analysis of randomised controlled trials (RCTs) for adults or children undergoing low-risk surgeries, comparing peri-operative TXA (any route or dose) with placebo or standard care informed the clinical effectiveness and a decision model adapted from NICE NG24, focusing on short-term hospital costs informed the cost-effectiveness analysis. We included 82 RCTs comprising 8506 participants. TXA significantly reduced blood loss (ratio of means 0·73, 95% CI 0·68,0·79) and transfusion rates (odds ratio 0·39, 95% CI 0·25,0·61). It also reduced hospital stay by 0·4 days (MD = -0·40 days, 95% CI = -0·77, -0·02) and improved pain scores at 1 and 2 weeks postoperatively. Evidence for thrombotic events was limited and inconclusive. The cost-effectiveness analysis showed TXA was cost-saving (£156 per patient) and had a 99% probability of being cost-effective at the £20lJ000 per QALY threshold. Reduction in bleeding and improved recovery outcomes even in surgeries with low anticipated blood loss support broader use of TXA in surgical care and suggests revisiting existing guidelines to include surgeries with any bleeding risk. Further research should examine long-term safety and patient-reported outcomes.
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- article
- Language
- en
- Landing Page
- https://doi.org/10.1101/2025.07.21.25331903
- https://www.medrxiv.org/content/medrxiv/early/2025/07/21/2025.07.21.25331903.full.pdf
- OA Status
- green
- References
- 93
- OpenAlex ID
- https://openalex.org/W4415836559
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Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4415836559Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1101/2025.07.21.25331903Digital Object Identifier
- Title
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Tranexamic acid in reducing expected blood loss in moderate to low risk surgeries: systematic review, meta-analysis and cost effectiveness analysisWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
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2025-07-21Full publication date if available
- Authors
-
Nishant Jaiswal, Giorgio Ciminata, William A. Robinson, Martin Taylor‐Rowan, Tom Morris, Clareece R. Nevill, Hasan Tahir, Elizabeth Fisher, Ryan J. Mulholland, Michael D. Lumsden, Anna H Noel-Storr, Andrew Davies, Nicola J. Cooper, Terence J. Quinn, Alex J. Sutton, Olívia WuList of authors in order
- Landing page
-
https://doi.org/10.1101/2025.07.21.25331903Publisher landing page
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https://www.medrxiv.org/content/medrxiv/early/2025/07/21/2025.07.21.25331903.full.pdfDirect link to full text PDF
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YesWhether a free full text is available
- OA status
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greenOpen access status per OpenAlex
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https://www.medrxiv.org/content/medrxiv/early/2025/07/21/2025.07.21.25331903.full.pdfDirect OA link when available
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0Total citation count in OpenAlex
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| abstract_inverted_index.safety | 241 |
| abstract_inverted_index.scores | 162 |
| abstract_inverted_index.should | 238 |
| abstract_inverted_index.showed | 180 |
| abstract_inverted_index.trials | 72 |
| abstract_inverted_index.-0·02) | 158 |
| abstract_inverted_index.-0·77, | 157 |
| abstract_inverted_index.Further | 236 |
| abstract_inverted_index.adapted | 101 |
| abstract_inverted_index.broader | 217 |
| abstract_inverted_index.examine | 239 |
| abstract_inverted_index.impact. | 48 |
| abstract_inverted_index.include | 230 |
| abstract_inverted_index.limited | 174 |
| abstract_inverted_index.placebo | 89 |
| abstract_inverted_index.reduced | 123, 144 |
| abstract_inverted_index.remains | 32 |
| abstract_inverted_index.support | 216 |
| abstract_inverted_index.Abstract | 0 |
| abstract_inverted_index.Evidence | 169 |
| abstract_inverted_index.However, | 21 |
| abstract_inverted_index.analysis | 179 |
| abstract_inverted_index.assessed | 50 |
| abstract_inverted_index.benefits | 43 |
| abstract_inverted_index.bleeding | 203, 234 |
| abstract_inverted_index.children | 77 |
| abstract_inverted_index.clinical | 42, 52, 95 |
| abstract_inverted_index.decision | 99 |
| abstract_inverted_index.existing | 227 |
| abstract_inverted_index.expected | 61 |
| abstract_inverted_index.focusing | 105 |
| abstract_inverted_index.hospital | 108, 145 |
| abstract_inverted_index.improved | 160, 205 |
| abstract_inverted_index.included | 115 |
| abstract_inverted_index.informed | 93, 110 |
| abstract_inverted_index.low-risk | 28, 79 |
| abstract_inverted_index.outcomes | 207 |
| abstract_inverted_index.patient) | 186 |
| abstract_inverted_index.recovery | 206 |
| abstract_inverted_index.reducing | 11 |
| abstract_inverted_index.research | 237 |
| abstract_inverted_index.standard | 91 |
| abstract_inverted_index.suggests | 225 |
| abstract_inverted_index.surgical | 222 |
| abstract_inverted_index.Reduction | 201 |
| abstract_inverted_index.analysis. | 113 |
| abstract_inverted_index.comparing | 81 |
| abstract_inverted_index.frequency | 36 |
| abstract_inverted_index.high-risk | 17 |
| abstract_inverted_index.long-term | 240 |
| abstract_inverted_index.outcomes. | 244 |
| abstract_inverted_index.surgeries | 15, 25, 58, 210, 231 |
| abstract_inverted_index.£20lJ000 | 197 |
| abstract_inverted_index.Tranexamic | 1 |
| abstract_inverted_index.classified | 26 |
| abstract_inverted_index.comprising | 118 |
| abstract_inverted_index.controlled | 71 |
| abstract_inverted_index.cumulative | 47 |
| abstract_inverted_index.guidelines | 228 |
| abstract_inverted_index.randomised | 70 |
| abstract_inverted_index.revisiting | 226 |
| abstract_inverted_index.short-term | 107 |
| abstract_inverted_index.surgeries, | 80 |
| abstract_inverted_index.systematic | 65 |
| abstract_inverted_index.threshold. | 200 |
| abstract_inverted_index.thrombotic | 171 |
| abstract_inverted_index.uncertain. | 33 |
| abstract_inverted_index.undergoing | 78 |
| abstract_inverted_index.anticipated | 213 |
| abstract_inverted_index.cost-saving | 183 |
| abstract_inverted_index.probability | 191 |
| abstract_inverted_index.procedures, | 39 |
| abstract_inverted_index.substantial | 46 |
| abstract_inverted_index.transfusion | 12, 134 |
| abstract_inverted_index.0·68,0·79) | 132 |
| abstract_inverted_index.intervention | 9 |
| abstract_inverted_index.requirements | 13 |
| abstract_inverted_index.0·25,0·61). | 141 |
| abstract_inverted_index.effectiveness | 96 |
| abstract_inverted_index.inconclusive. | 176 |
| abstract_inverted_index.meta-analysis | 68 |
| abstract_inverted_index.participants. | 120 |
| abstract_inverted_index.significantly | 122 |
| abstract_inverted_index.cost-effective | 194 |
| abstract_inverted_index.peri-operative | 82 |
| abstract_inverted_index.patient-reported | 243 |
| abstract_inverted_index.postoperatively. | 168 |
| abstract_inverted_index.well-established | 5 |
| abstract_inverted_index.cost-effectiveness | 54, 112, 178 |
| cited_by_percentile_year | |
| corresponding_author_ids | https://openalex.org/A5085782112 |
| countries_distinct_count | 3 |
| institutions_distinct_count | 16 |
| corresponding_institution_ids | https://openalex.org/I153648349, https://openalex.org/I4210162663 |
| citation_normalized_percentile |