A Comparison of the Use of Tranexamic Acid versus Placebo in Patients Undergoing Excision of Intracranial Meningioma

Authors

  • Adnan Khalid
  • Usman Nazir
  • Naeem Raza
  • Sheraz Aslam
  • Muhammad Naveed Majeed
  • Zohaib Hassan

DOI:

https://doi.org/10.36552/pjns.v26i4.822

Keywords:

Tranexamic acid

Abstract

Objective:  Complete surgical removal of intracranial meningiomas is curative but with significant blood loss. Tranexamic acid has been proven beneficial in reducing blood loss following major surgical procedures. Therefore, the purpose of the study was to evaluate how well tranexamic acid worked to stop blood loss in patients having an intracranial meningioma removed.

Objective:  This study compares the effects of tranexamic acid and placebo on intraoperative blood loss, transfusion needs, and the frequency of surgical sites with good hemostatic quality in patients having an intracranial meningioma removed.

Materials & Methods:  This clinical trial was carried out in the Department of Neurosurgery, unit II PGMI/ PINS, Lahore over 1 year. Two equal groups of 30 individuals each were formed from a total of 60 patients having an intracranial meningioma diagnosis. Group 1 was given TXA, whereas Group 2 was given a placebo (normal saline). Patients were assessed for intraoperative blood loss, transfusion needs, and a clean surgical area in terms of hemostasis.

Results:  Mean blood loss in the TXA group was 803.0 ± 106.53mL while that in the placebo group was 1159.5 ± 101.79 mL which was statistically significant (p = 0.000). TXA also significantly reduced transfusion requirements (p = 0.000) and was associated with better hemostasis of the surgical field (p = 0.000).

Conclusion:  This study concluded that TXA can reduce intraoperative blood loss and decrease the transfusion requirements in the postoperative period significantly as compared to placebo in patients experiencing surgical intracranial meningioma excision.

References

Han MS, Kim YJ, Moon KS, Lee KH, Yang JI, Kang WD, et al. Lessons from surgical outcome for intracranial meningioma involving major venous sinus. Casey. K, ed. Medicine, 2016; 95 (35): e4705.

Hsu SY, Ou CY, Ho YN, Huang YH. Application of Surgical Apgar Score in intracranial meningioma surgery. PLoS ONE, 2017; 12 (4): e0174328.

Hsu SY, Huang YH. Characterization and prognostic implications of significant blood loss during intracranial meningioma surgery. Transl Cancer Res. 2016; 5 (6): 797-804.

Hooda B, Chouhan RS, Rath GP, Bithal PK, Suri A, Lamsal R. Effect of tranexamic acid on intraoperative blood loss and transfusion requirements in patients undergoing excision of intracranial meningioma. J Clin Neurosci. 2017; 41: 132-8.

Vel R, Udupi BP, Satya Prakash MVS, Adinarayanan S, Mishra S, Babu L. Effect of low dose tranexamic acid on intra-operative blood loss in neurosurgical patients. Saudi J Anaesth. 2015; 9 (1): 42–8.

Shakur H, Beaumont D, Pavord S, Gayet-Ageron A, Ker K, Mousa HA. Antifibrinolytic drugs for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. 2018; 2: CD012964.

Roberts I, Shakur H, Coats T, Hunt B, Balogun E, BarnetsonL, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013; 17 (10): 1-79.

Amer KM, Rehman S, Amer K, Haydel C. Efficacy and safety of tranexamic acid in orthopaedic fracture surgery: a meta-analysis and systemic literature review. J Orthop Trauma. 2017; 31 (10): 520-5.

Colomina MJ, Koo M, Basora M, Pizones J, Mora L, Bagó J. Intraoperative tranexamic acid use in major spine surgery in adults: a multicenter, randomized, placebo-controlled trial. Br J Anaesth. 2017; 118 (3): 380-90.

Azeemuddin M, Nizamani WM, Tariq MU, Wasay M. Role of ADC values and ratios of MRI scan in differentiating typical from atypical/anaplastic meningiomas. J Pak Med Assoc. 2018; 68 (9): 1403-6.

Malik TG, Farooq K, Khalil M. Clinical and neuro-imaging patterns of meningiomas of visual pathway. Pak J Ophthalmol. 2015; 31 (2): 101-4.

Nania A, Granata F, Vinci S, Pitrone A, Barresi V, Morabito R, et al. Necrosis score, surgical time, and transfused blood volume in patients treated with preoperative embolization of intracranial meningiomas. Analysis of a single-centre experience and a review of literature. Clin Neuroradiol. 2014; 24 (1): 29-36.

Bhat AR, Wani MA, Kirmani AR, Ramzan AU. Histological – subtypes and anatomical location correlated in meningeal brain tumors (meningiomas). J Neurosci Rural Pract. 2014; 5 (3): 244-9.

Krishnan GR, Panda NB, Wig J, Singla N, Mukherjee KK, Aluhwahia J. Effect of tranexamic acid on blood loss and the quality of surgical field in meningioma resection surgery. JNACC. 2015; 2 (2): 158.

Bukhari SS, Shamim MS. Utility of tranexamic acid to minimize blood loss in brain tumour surgery. JPMA. The Journal of the Pakistan Medical Association, 2020; 70 (4): 764.

Brown NJ, Wilson B, Ong V, Gendreau JL, Yang CY, Himstead AS, Shahrestani S, Shlobin NA, Reardon T, Choi EH, Birkenbeuel J. The Use of Tranexamic Acid for Elective Resection of Intracranial Neoplasms: A Systematic Review. World Neurosurgery. 2022 Jan 4.

Downloads

Published

2023-01-28

Issue

Vol. 26 No. 4 (2022): October-December

Section

Original Articles

License

Copyright (c) 2023 Pakistan Journal Of Neurological Surgery

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).