 Anti-fibrinolytic agents are widely used in surgery to reduce blood loss and the need for blood transfusion. A systematic review of randomised controlled trials of anti-fibrinolytic agents in elective surgery showed that tranexamic acid TXA reduced the risk of blood transfusion by a relative 39 RR 0.61, 95 CI 0.54 to 0.69. In those requiring transfusion, TXA reduced the transfused blood volume by 1.1 units 95 CI 0.64 to 1.59. Anti-fibrinolytic agents also reduced the need for re-operation due to bleeding RR0.52: 95 CI 0.40 to 0.69. There was no evidence of an increased risk of thrombotic events. 