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Published April 2022 | public
Journal Article

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

Abstract

Background: As an established antifibrinolytic agent, tranexamic acid (TXA) has garnered widespread use during surgery to limit intraoperative blood loss. In the field of neurosurgery, TXA is often introduced in cases of traumatic brain injury or elective spine surgeries; however, its role during elective cranial surgeries is not well established. We report a systematic review of the use of TXA in elective surgical resection of intracranial neoplasms. Methods: We performed this systematic review following PRISMA guidelines to identify studies investigating the use of TXA in elective neurosurgical resection of intracranial neoplasms. Variables extracted included patient demographics, surgical indications, type of surgery performed, TXA dose and route of administration, operative duration, blood loss, transfusion rate, postoperative hemoglobin level, and complications. Results: After careful screening, 4 articles (consisting of 682 patients) met our inclusion/exclusion criteria. The studies included 2 prospective cohort studies, 1 retrospective cohort study, and 1 case series. A χ2 test of pooled data demonstrated that patients administered TXA had a significantly decreased need for blood transfusions during surgery (odds ratio, 0.6273; 95% confidence interval, 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 the studies. There was no significant difference in postoperative hemoglobin levels, with a mean of 11.4 g/dL in both the TXA and control groups. Conclusions: These results support the use of intraoperative TXA in tumor resection. However, its role in tumor resection has been less well investigated compared with its use in other areas of neurosurgery.

Additional Information

© 2022 Elsevier. Received 27 November 2021, Accepted 30 December 2021, Available online 4 January 2022. CRediT authorship contribution statement: Nolan J. Brown: Conceptualization, Methodology, Acquisition of Data, Formal analysis, Data curation, Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Bayard Wilson: Conceptualization, Methodology, Formal analysis, Data curation, Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Vera Ong: Acquisition of Data, Formal analysis, Data curation, Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Julian L. Gendreau: Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Chen Yi Yang: Acquisition of Data, Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Alexander S. Himstead: Acquisition of Data, Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Shane Shahrestani: Acquisition of Data, Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Nathan A. Shlobin: Acquisition of Data, Writing – review & editing, Reviewed Submitted Version. Taylor Reardon: Acquisition of Data, Writing – review & editing, Reviewed Submitted Version. Elliot H. Choi: Acquisition of Data, Formal analysis, Data curation, Writing – review & editing, Reviewed Submitted Version. Jack Birkenbeuel: Acquisition of Data, Writing – review & editing, Reviewed Submitted Version. Sebastian J. Cohn: Acquisition of Data, Writing – review & editing, Reviewed Submitted Version. Ronald Sahyouni: Acquisition of Data, Writing – original draft, Writing – review & editing, Reviewed Submitted Version. Isaac Yang: Conceptualization, Methodology, Writing – review & editing, Reviewed Submitted Version, Approved Final Version on Behalf of all Authors, Supervision. Chan: Writing – original draft.

Additional details

Created:
August 22, 2023
Modified:
October 23, 2023