Effect of low dose tranexamic acid on intra-operative blood loss in neurosurgical patients

Background: Major blood loss during neurosurgery may result in a variety of complications, such as potentially fatal hemodynamic instability. Brain tumor and skull base surgery is among the high bleeding risk procedures. Tranexamic acid (TXA) has been found to reduce bleeding events in various fields of medicine. Methods: We searched for all randomized controlled trials published in English or Bahasa which compared the use of TXA with placebo in brain tumor surgery. The studies should include adult patients with intracranial tumor who received TXA before skin incision. The primary and secondary outcomes are intraoperative blood loss and the need of transfusion. Results: This meta-analysis included a total of 200 patients from three studies. TXA resulted in less blood loss with pooled mean difference of −292.80 (95% CI, −431.63, −153.96, P<0.05). The need of transfusion was not significant between TXA and control group (pooled mean difference −85.36, 95% CI, −213.23 – (42.51), P=0.19). Conclusion: TXA reduced the volume of blood loss but did not reduce the need of blood transfusion.

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“…After careful consideration from each authors, we decided to include three studies. [ 19 , 37 , 39 ] All of them were RCTs.…”

Section: Resultsmentioning

confidence: 99%

“…It was not clearly stated who prepared the TXA. [ 37 ] Vel et al . used a computer-generated randomization chart to allocate the patient.…”

Section: Resultsmentioning

confidence: 99%

Tranexamic acid to reduce operative blood loss in brain tumor surgery: A meta-analysis

Prastikarunia¹,

Wahyuhadi²,

Susilo³

et al. 2021

Surgical Neurology International

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“…Many RCTs have shown that TXA treatment could considerably reduce the risk of rebleeding [11-13, 15, 16], the curative effect is closely related to its pharmacological action [19,20]. TXA can inhibit brinolysis by replacing plasminogen from brin and also inhibits enzymatic degradation by plasmin [21,22]. Nevertheless, in the recent publication of the ULTRA, rebleeding after randomization and before aneurysm treatment occurred in the tranexamic acid and control group did not reach the prede ned threshold for statistical signi cance, perhaps because half of the rebleeding occurred within 3 hours, in this trial, the median interval time from symptomatic onset to treatment was 3 hours, a considerable proportion of rebleeds had occurred.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: A Meta-analysis of Randomized Controlled Trials

Liu

Ding

Xue

2021

Preprint

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BackgroundTranexamic acid, as a hemostatic drug, is widely used to treat or prevent excessive blood loss. The efficacy of tranexamic acid in promoting good clinical outcomes, reducing mortality, and the occurrence of adverse events during treatment of aneurysmal subarachnoid hemorrhage remains unclear.MethodsPubMed, Web of Science, Embase, and The Cochrane Library were searched for randomized-controlled trials (from1980 to 2021) following strict inclusion and exclusion criteria. We performed STATA 16.0 and RevMan 5.3 for statistical analysis. Fixed-effect model (M-H method) and effect size RR (95% CI) were used as a pooled measure to combine the heterogeneous data. We also performed post hoc sensitivity analyses and conducted subgroup analyses to evaluate each outcome with low heterogeneity results.ResultsMeta-analysis showed that tranexamic acid was associated with reduced rebleeding(RR 0.72 [0.59, 0.87], p= 0.0008; I2:0%, p = 0.51). Tranexamic acid probably has no effect on good clinical outcome or mortality (RR 0.98 [0.92,1.04], p = 0.51; I2: 0%, p = 0.60; RR 1.01 [0.88,1.15], p=0.91; I2:0%, p = 0.51).TXA was associated with increased hydrocephalus (RR 1.13 [1.02, 1.24], p = 0.02; I2:0%, p = 0.61), DCI (RR 1.70 [1.34, 2.16], p < 0.0001; I2: 0%, p= 0.84) and seizure (RR 1.46 [1.00, 2.14], p= 0.05),The rate for thromboembolic complications were similar in both groups(RR 0.91 [0.63, 1.31], p = 0.62;I2: 0%, p = 0.73). There was significant drug related overall adverse events (RR 1.21 [1.11, 1.32], p < 0.0001; I2: 29%, p = 0.14).ConclusionsIn patients with aneurysmal subarachnoid hemorrhage, these findings indicate that it does not support the routine use of TXA.

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“…The studies including patients with liver, prostate and gynecological cancer found a reduction in blood transfusion requirements during and after surgery in the TXA arms [ 36 , 37 , 38 , 39 , 40 , 41 ]. In contrast, antifibrinolytics did not influence bleeding outcomes in major orthopedic cancer surgery or in oncologic spinal canal, head and neck and neurosurgeries [ 42 , 43 , 44 , 45 ].…”

Section: Managing Thrombocytopenia In Cancermentioning

confidence: 99%

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Leader

Hofstetter

Spectre

2021

JCM

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Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been studied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

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Effect of low dose tranexamic acid on intra-operative blood loss in neurosurgical patients

Cited by 31 publications

References 32 publications

Tranexamic acid to reduce operative blood loss in brain tumor surgery: A meta-analysis

Tranexamic acid to reduce operative blood loss in brain tumor surgery: A meta-analysis

Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: A Meta-analysis of Randomized Controlled Trials

Challenges and Advances in Managing Thrombocytopenic Cancer Patients

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