ORCID

Abstract

Background: Tranexamic acid (TXA) is widely used to reduce perioperative bleeding in several surgical specialties; however, its role in vascular surgery remains uncertain. Concerns regarding arterial, venous and graft thrombosis, together with limited and low-certainty evidence of efficacy, have contributed to variation in practice across the UK. According to the 2025 National Vascular Registry there were nearly 20,000 major vascular operations carried out across the four nations. The 2023 NHS Blood and Transplant audit found TXA uptake in vascular surgery to be low (26.5%) when compared with other specialties such as cardiac, orthopaedic and trauma surgery, which each had TXA use over 80%. We set out to understand clinician perspectives to inform the design and possible need for a future trial.Methods: We conducted a national cross-sectional survey of vascular anaesthetists and surgeons across the UK between December 2024 and June 2025. The questionnaire assessed TXA use in elective and emergency vascular procedures, perceptions of bleeding and thrombotic risk, and views on the adequacy of existing evidence and the feasibility of a future randomised controlled trial (RCT). Quantitative data were analysed descriptively and free-text responses were analysed thematically.Results: A total of 142 responses were received from 49/65 (74.6%) UK vascular units. This included 85 anaesthetists and 57 surgeons, the majority of whom were consultant grade. Routine TXA use was uncommon across elective procedures, while selective use increased in the context of major haemorrhage, particularly during emergency surgery. Respondents perceived carotid surgery and lower limb revascularisation as carrying the highest risk of arterial or graft thrombosis, whereas trauma and major lower limb amputation were viewed as highest risk for venous thromboembolism; these perceptions were reflected in reported practice. Support for further research was high: 67/85 anaesthetists (79%) and 36/57 surgeons (63%) believed that an RCT evaluating TXA in vascular surgery is needed, with most favouring inclusion of both elective and emergency procedures. Willingness to recruit patients was reported by 77/85 anaesthetists (90%) and 42/57 surgeons (74%), although respondents noted that recruitment would depend on procedure type and multidisciplinary agreement. Safety considerations dominated views on trial design. Graft or arterial thrombosis up to 90 days was prioritised by 83/85 anaesthetists (98%) and 53/57 surgeons (93%), followed by return to theatre for bleeding or thrombosis and transfusion requirements. Most respondents (74/85 anaesthetists (87%) and 45/57 surgeons (79%)) indicated they would change practice if a well-designed trial demonstrated both safety and efficacy.Conclusion: TXA use in vascular surgery is variable and context dependent. There is substantial clinical equipoise and strong support for a randomised trial, providing the study design reflects procedural heterogeneity and prioritises safety-related outcomes.

Publication Date

2026-02-27

Publication Title

Journal of Vascular Societies Great Britain & Ireland

Volume

5

Issue

2

ISSN

2754-0022

Acceptance Date

2026-02-23

Deposit Date

2026-06-03

Funding

AS has received consultancy fees from Pharmacosmos (UK) outside of the submitted work.

First Page

77

Last Page

84

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