Efficacy and Safety of Tranexamic Acid on Blood Loss and Seizures in Patients Undergoing Meningioma Resection: A Systematic Review and Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Sep 4

PMID 39231164

Authors

Xiaoyuan Liu

Minying Liu

Shu Li

Yue Ren

Maoyao Zheng

Min Zeng

Yuming Peng

Affiliations

Soon will be listed here.

Abstract

Introduction: It is unclear how tranexamic acid (TXA) affects blood loss and seizures in meningioma resections. We performed a systematic review and meta-analysis and tried to evaluate the effectiveness and safety of TXA use for patients undergoing meningioma resections.

Methods: Regards to this systematic review and meta-analysis (registered with CRD42023416693), we searched PubMed, Embase (Ovid), EBSCO, and Cochrane central library up to and including Oct 2023. Patients undergoing meningioma resections treated with TXA and placebo or no treatment were eligible for this study. This would allow delineation of the impact of TXA on blood loss, postoperative seizure, and other complication incidences.

Results: Four prospective cohort studies with 781 patients (390 patients in the TXA group and 391 patients in the control group) were conducted via a systematic review and meta-analysis. The results suggested that the application of TXA for patients undergoing meningioma resections reduced mean blood loss of 252 mL with 95% confidence interval (CI) -469.26 to -34.67 (P = 0.02) and I2 of 94% but did not increase postoperative seizure (risk ratio: 1.08; 95%CI: 0.54 to 2.15; P = 0.84) and other complication rates.

Conclusions: This systematic review and meta-analysis suggests that the administration of TXA could reduce blood loss in patients undergoing intracerebral meningioma resection.

Registry Information: The systematic review protocol has been registered at PROSPERO (Registration No. CRD42023416693) on April 23, 2023.

References

Ravi G, Panda N, Ahluwalia J, Chauhan R, Singla N, Mahajan S . Effect of tranexamic acid on blood loss, coagulation profile, and quality of surgical field in intracranial meningioma resection: A prospective randomized, double-blind, placebo-controlled study. Surg Neurol Int. 2021; 12:272. PMC: 8247710. DOI: 10.25259/SNI_296_2021. View

Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y . Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376(9734):23-32. DOI: 10.1016/S0140-6736(10)60835-5. View

Levy J, Koster A, Quinones Q, Milling T, Key N . Antifibrinolytic Therapy and Perioperative Considerations. Anesthesiology. 2017; 128(3):657-670. PMC: 5811331. DOI: 10.1097/ALN.0000000000001997. View

Murkin J, Falter F, Granton J, Young B, Burt C, Chu M . High-dose tranexamic Acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg. 2009; 110(2):350-3. DOI: 10.1213/ANE.0b013e3181c92b23. View

Rajagopalan V, Chouhan R, Pandia M, Lamsal R, Rath G . Effect of Intraoperative Blood Loss on Perioperative Complications and Neurological Outcome in Adult Patients Undergoing Elective Brain Tumor Surgery. J Neurosci Rural Pract. 2019; 10(4):631-640. PMC: 6906102. DOI: 10.1055/s-0039-3399487. View

Ortmann E, Besser M, Klein A . Antifibrinolytic agents in current anaesthetic practice. Br J Anaesth. 2013; 111(4):549-63. DOI: 10.1093/bja/aet154. View

Huang F, Wu D, Ma G, Yin Z, Wang Q . The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis. J Surg Res. 2013; 186(1):318-27. DOI: 10.1016/j.jss.2013.08.020. View

Li S, Liu M, Yang J, Yan X, Wu Y, Zhang L . Intravenous tranexamic acid for intracerebral meningioma resections: A randomized, parallel-group, non-inferiority trial. J Clin Anesth. 2023; 92:111285. DOI: 10.1016/j.jclinane.2023.111285. View

Rebai L, Mahfoudhi N, Fitouhi N, Daghmouri M, Bahri K . Intraoperative tranexamic acid use in patients undergoing excision of intracranial meningioma: Randomized, placebo-controlled trial. Surg Neurol Int. 2021; 12:289. PMC: 8247750. DOI: 10.25259/SNI_177_2021. View

10.

Baldi I, Engelhardt J, Bonnet C, Bauchet L, Berteaud E, Gruber A . Epidemiology of meningiomas. Neurochirurgie. 2014; 64(1):5-14. DOI: 10.1016/j.neuchi.2014.05.006. View

11.

Horrow J, Van Riper D, Strong M, Grunewald K, Parmet J . The dose-response relationship of tranexamic acid. Anesthesiology. 1995; 82(2):383-92. DOI: 10.1097/00000542-199502000-00009. View

12.

Fathi A, Roelcke U . Meningioma. Curr Neurol Neurosci Rep. 2013; 13(4):337. DOI: 10.1007/s11910-013-0337-4. View

13.

Hemapriya L, More G, Kumar A . Efficacy of Tranexamic Acid in Reducing Blood Loss in Lower Segment Cesearean Section: A Randomised Controlled Study. J Obstet Gynaecol India. 2021; 70(6):479-484. PMC: 7758378. DOI: 10.1007/s13224-020-01351-3. View

14.

Dunn C, Goa K . Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999; 57(6):1005-32. DOI: 10.2165/00003495-199957060-00017. View

15.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

16.

Kagoma Y, Crowther M, Douketis J, Bhandari M, Eikelboom J, Lim W . Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res. 2008; 123(5):687-96. DOI: 10.1016/j.thromres.2008.09.015. View

17.

Adler Ma S, Brindle W, Burton G, Gallacher S, Hong F, Manelius I . Tranexamic acid is associated with less blood transfusion in off-pump coronary artery bypass graft surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2010; 25(1):26-35. DOI: 10.1053/j.jvca.2010.08.012. View

18.

Wijaya J, July J, Quintero-Consuegra M, Chadid D . A systematic review and meta-analysis of the effects of tranexamic acid in surgical procedure for intracranial meningioma. J Neurooncol. 2023; 161(2):383-393. DOI: 10.1007/s11060-023-04237-2. View

19.

Vel R, Udupi B, Satya Prakash M, 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. PMC: 4279349. DOI: 10.4103/1658-354X.146304. View

20.

Hooda B, Chouhan R, Rath G, Bithal P, 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; 41:132-138. DOI: 10.1016/j.jocn.2017.02.053. View