Economic aspects and organization

Abstract

Both bleeding and allogeneic blood transfusion independently increase morbidity, mortality, length of stay in ICU and in hospital, as well as hospital costs. Furthermore, ischemic and thromboembolic events are associated with increased in-hospital and posthospital costs.Lysine analogues (tranexamic acid and ε-aminocaproic acid) reduce perioperative blood loss and transfusion requirements and can be highly cost-effective in numerous major surgery and trauma settings. In contrast, the use of rFVIIa should be restricted to its licensed indications since outside of these its effectiveness in reducing transfusion requirements and mortality remains unproven, while the risk of arterial thromboembolic events and costs are high.Cell salvage has been shown to be cost-effective in minimizing perioperative transfusion of allogeneic blood products. The current literature does not clarify whether a formula-driven transfusion protocol reduces or increases hospital costs. On the other hand, implementation of transfusion and coagulation management algorithms based on point-of-care testing (thromboelastometry/thromboelastography or whole blood impedance aggregometry) can reduce both adverse events and costs associated with transfusion in trauma, cardiac surgery, and liver transplantation. In these settings, first-line, calculated, goal-directed therapy with coagulation factor concentrates (fibrinogen concentrate and/or prothrombin complex concentrate), guided by thromboelastometry, seems to be effective in reducing transfusion-associated costs in selected patients, without increasing the incidence of thromboembolic events.