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Hintergrund: Tranexamsäure (TXA) ist ein Antifibrinolytikum, welches Blutungen effizient reduzieren kann. Auf Grund des Wirkmechanismus bestehen jedoch Bedenken, dass TXA zu einem erhöhten Risiko für thromboembolische Ereignisse (TE) führen könnte. Zielsetzung: Ziel dieser Arbeit ist die Untersuchung eines möglichen Zusammenhanges zwischen der Applikation intravenöser (iv) TXA und dem Auftreten von TE sowie der Mortalität. Ebenfalls soll ein möglicher Dosis-abhängiger Effekt untersucht werden. Methoden: Es erfolgte eine systematische Suche der MEDLINE Datenbank und des Cochrane Central Register of Controlled Trials. Berücksichtigt wurden alle randomisiert kontrollierten Studien bis inklusive 2020, welche iv TXA mit Placebo oder einer Kontrollgruppe ohne Intervention verglichen. Die eingeschlossenen Studien sind in englischer, deutscher, spanischer oder französischer Sprache publiziert. Übergeordnete Endpunkte waren die Summe aller TE sowie die Gesamtmortalität. Zusätzlich wurden die Endpunkte venöse Thrombosen, Lungenembolien, venöse thromboembolische Ereignisse (VTE), Myokardinfarkte, Schlaganfälle oder transitorische ischämische Attacken, Mesenterialischämien, arterielle Verschlüsse, blutungsassoziierte Mortalität sowie nicht-blutungsassoziierte Mortalität untersucht. Anhand der „Preferred Reporting Items for Systematic Reviews and Meta-Analyses“ (PRISMA) wurden die vorliegende Metaanalyse, Subgruppen- und Sensitivitätsanalyse erstellt. Als Effektstärkemaß wurde die Risikodifferenz (RD) berechnet. Für den primären Endpunkt der Summe aller TE erfolgten zusätzliche Sensitivitätsanalysen zur Berechnung des Risikoquotienten (RR). Eine Metaregressionsanalyse wurde zur Untersuchung eines dosisabhängigen Effektes durchgeführt. Das Bias-Risiko der eingeschlossenen Studien wurde anhand des Cochrane Risk of Bias Tool bewertet. Ergebnisse: Insgesamt wurden 216 Studien in die vorliegende Metaanalyse eingeschlossen. Die Summe aller TE betrug 1020 (2,1%) in der TXA-Gruppe und 9, Background: Tranexamic acid (TXA) is an antifibrinolytic agent which efficiently reduces bleeding. However, due to its mechanism of action, concerns remain whether TXA could lead to an increased risk of thromboembolic events. Aim of the Study: The aim of this study is to examine a possible association between the application of intravenous tranexamic acid and thromboembolic events and mortality in patients of any medical discipline and of all ages. Methods: We systematically searched MEDLINE and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials until 2020 that compared intravenous TXA with placebo or no treatment and were published in English, German, Spanish or French. The main endpoints were total thromboembolic events and overall mortality. Additional endpoints were venous thrombosis, pulmonary embolism, venous thromboembolic events, myocardial infarction or ischaemia, cerebral infarction or ischaemia, mesenteric ischemia, limb ischaemia, hepatic artery thrombosis, bleeding mortality and non-bleeding mortality. This metaanalysis was carried out according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA). We assessed the risk difference (RD) using the fixed-effect model. Sensitivity analyses were conducted using the random-effects model. We additionally assessed the risk ratio (RR) as a sensitivity analysis of the main endpoint of total thromboembolic events. To investigate a dose-dependent effect we conducted a metaregression analysis. The risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: In total, 216 studies were included in this metaanalysis. We found 1020 (2.1%) and 900 (2.0%) total thromboembolic events in the TXA group and control group. No association was found between intravenous TXA and total thromboembolic events (RD = 0.001; 95% confidence interval (CI): -0.001 to 0.002; P = 0.49), venous thrombosis, pulmonary embolism, venous thromboembolic events, myocard

Background and Objectives: Patient Blood Management (PBM) is the timely application of evidence‐based medical and surgical concepts designed to improve haemoglobin concentration, optimize haemostasis and minimize blood loss in an effort to improve patient outcomes. The focus of this cost‐benefit analysis is to analyse the economic benefit of widespread implementation of a multimodal PBM programme. Materials and Methods: Based on a recent meta‐analysis including 17 studies (>235 000 patients) comparing PBM with control care and data from the University Hospital Frankfurt, a cost‐benefit analysis was performed. Outcome data were red blood cell (RBC) transfusion rate, number of transfused RBC units, and length of hospital stay (LOS). Costs were considered for the following three PBM interventions as examples: anaemia management including therapy of iron deficiency, use of cell salvage and tranexamic acid. For sensitivity analysis, a Monte Carlo simulation was performed. Results: Iron supplementation was applied in 3·1%, cell salvage in 65% and tranexamic acid in 89% of the PBM patients. In total, applying these three PBM interventions costs €129·04 per patient. However, PBM was associated with a reduction in transfusion rate, transfused RBC units per patient, and LOS which yielded to mean savings of €150·64 per patient. Thus, the overall benefit of PBM implementation was €21·60 per patient. In the Monte Carlo simulation, the cost savings on the outcome side exceeded the PBM costs in approximately 2/3 of all repetitions and the total benefit was €1 878 000 in 100·000 simulated patients. Conclusion: Resources to implement a multimodal PBM concept optimizing patient care and safety can be cost‐effectively.