Cost implications

Both bleeding and transfusion of allogeneic blood products independently increase morbidity, mortality, length of stay in ICU and hospital and costs. B

Tranexamic acid can reduce perioperative blood loss and transfusion requirements; this can be highly cost-effective in several major surgical and trauma settings. B

We recommend restricting the use of rFVIIa to its licensed indication as, outside these indications, the effectiveness of rFVIIa to reduce transfusion requirements and mortality remains unproven and the risk of arterial thromboembolic events, as well as costs, are high. 1A

Cell salvage can be cost-effective in selected patients. A

The cost-effectiveness of a ratio-driven transfusion protocol has not been investigated.

Goal-directed therapy with coagulation factor concentrates (fibrinogen and/or PCC) may reduce transfusionassociated costs in trauma, cardiac surgery and liver transplantation. C