The Use of Tranexamic Acid for Elective Resection of Intracranial Neoplasms: A Systematic Review

Department of Neurological Surgery, University of California, Irvine, Irvine, CA. Department of Neurological Surgery, University of California, Los Angeles, CA. John A. Burns School of Medicine, University of Hawaii, Honolulu HI. Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD. Electronic address: Keck School of Medicine of USC, Los Angeles, CA; Medical Scientist Training Program, California Institute of Technology, Pasadena, CA. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL. Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY. Department of Neuroscience, University of Pittsburgh, PA. Department of Neurological Surgery, University of California, San Diego, La Jolla, California.

World neurosurgery. 2022
BACKGROUND As an established antifibrinolytic agent, tranexamic acid (TXA) has garnered widespread use during surgery to limit intraoperative blood loss. Within the field of neurosurgery, it is often introduced in cases of traumatic brain injury or elective spine surgeries. However, its role during elective cranial surgeries is not well established. This study presents a systematic review of the use of TXA for elective surgical resection of intracranial neoplasms. METHODS We performed a systematic review using PRISMA guidelines to identify studies investigating the TXA use in elective neurosurgical resection of intracranial neoplasms. Variables extracted included patient demographics, surgical indications, type of surgery performed, TXA administration dose and route, operative duration, blood loss, transfusion rate, postoperative hemoglobin (Hb) levels, and complications. RESULTS After careful screening, 4 articles (consisting of 682 total patients) fit our inclusion/exclusion criteria. Two studies were prospective cohorts, one was a retrospective cohort, and one was a case series. Chi-squared testing of pooled data demonstrated that patients administered TXA had a significantly decreased need for blood transfusions during surgery (OR: 0.6273, 95% CI:0.4254-0.9251, p=0.018). Mean total blood loss was 821.9 mL in the TXA group and 1099.0 mL in the control group across studies. There was no significant difference in postoperative hemoglobin levels: means were 11.4 g/dL for both the TXA and control groups. CONCLUSION These results support the use of intraoperative TXA in tumor resection. However, its role in tumor resection has been less investigated when compared to the use of TXA in other areas of neurosurgery.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine