Effect of Tranexamic Acid Infusion to Reduce Intraoperative Blood Loss in Large Meningioma:  A Prospective Randomized Control Study (Preliminary Report)

Pathomporn Pin-on; Ananchanok      Sarinkarinkul; Prangmalee  Leurcharusmee; Settapong Boonsri; Kevin  Chotinaruemol

Authors

Pathomporn Pin-on Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0001-7371-8433
Ananchanok Sarinkarinkul Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-9375-4017
Prangmalee Leurcharusmee Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-3934-9002
Settapong Boonsri Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-6404-0234
Kevin Chotinaruemol Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0009-0005-2783-187X

Keywords:

tranexamic acid, meningioma, blood loss, blood transfusion

Abstract

Objective Resection of intracranial meningioma has been related to significant blood loss. Intravenous tranexamic acid (TXA) has been shown to successfully attenuated blood loss and transfusion in various surgical procedures. However, the evidence has been limited in the surgical management of brain tumors. This study aims to evaluate the efficacy of intravenous TXA in reducing intraoperative blood loss and the need for blood transfusion during the surgical resection of intracranial meningiomas.

Methods We conducted a prospective, randomized double-blind controlled study aiming for a sample size of 44 patients. In this preliminary report, twenty-five patients aged 18-60 years with large intracranial meningioma undergoing elective meningioma resection were enrolled and randomized to receive either TXA or a placebo. “Large meningioma” was defined as a radiographic finding of a tumor with a diameter > 5 cm in at least 2 dimensions. The TXA group was administered TXA at 20 mg/kg over 20 minutes, prior to the operation, followed by an infusion of 1 mg/kg/hr until the end of the operation. The primary outcome measure was volume of intraoperative blood loss. Continuous variables were analyzed with Student’s t-test or the Mann-Whitney U-test depending upon the distribution of the data. Fisher’s exact test was used to compare categorical variables.

Results Twenty-five patients were randomized with 12 in the TXA group and 13 in the placebo group. Baseline characteristics of the patients in the two groups were similar. The median intraoperative blood loss volume was 1,925 mL (IQR=1,575) in the TXA group and 1,500 mL (IQR=1,700) in the placebo group (p = 0.904). The median of intraoperative packed red cells (PRC) transfusion volume was 801.5 mL (IQR=825.5) in the TXA group and 493 mL (IQR=856) in the placebo group (p = 0.883). There was no significant difference in blood transfusion volumes between the groups in first 24 hours after surgery (p = 0.581). The incidence of thromboembolic events was similar in the two groups (p = 1.0). No postoperative seizures occurred in either group during the study.

Conclusions TXA did not reduce intraoperative blood loss, the intraoperative transfusion requirement, and the transfusion requirements during the first 24 hours after surgery in patients who underwent large intracranial meningioma resection.

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