Given that surgery is no more than "elective trauma" it is not surprising that the results of studies of tranexamic acid in trauma patients are similar to those seen in the surgical population. But what about other conditions such as postpartum haemorrhage, gastrointestinal bleeding, cerebral and subarachnoid haemorrhage? Are we going to have to wait for well performed randomised controlled clinical trials of thousands of patients before we treat our patients? Clot stabilisation is in my view a rational and essential part of the management of anyone who appears to be "bleeding to death" or has a bleed into a confined space such as their cranium! Blood is a scarce resource, blood products have their own complications and the cranium is a limited space so anything that might reduce the chances of "bleeding to death" and the requirement for blood products requires careful consideration!

What might be the adverse effects of tranexamic acid in the bleeding population? An increased incidence of venous thrombosis is an important consideration as the recovering bleeding patient does become 'prothrombotic' but there is little evidence of this in the studies performed to date. Moreover, even if this was the case, venous thrombosis is easy to diagnose and relatively simple to treat.

Better to be alive with a blood clot rather than to have died from bleeding!

Competing interests: None declared