Neuro-oncologic applications of tranexamic acid: Systematic review and meta-analysis

Area of Science:

• Neurosurgery
• Oncology
• Pharmacology

Background:

• Central nervous system (CNS) neoplasms pose surgical challenges with significant blood loss.
• Antifibrinolytic agents, such as tranexamic acid (TXA), are explored to mitigate surgical bleeding.
• The risk of venous thromboembolic events (VTEs) associated with TXA use is a critical consideration.

Purpose of the Study:

• To review the evidence on TXA's efficacy in reducing blood loss during CNS tumor resection.
• To assess the safety of TXA, specifically its association with VTEs, in this patient population.
• To compare the risks of TXA with those of allogeneic blood transfusions.

Main Methods:

• A systematic literature search was conducted across three databases for studies on TXA use in CNS tumor surgery.
• Data extracted included blood loss (EBL/IOBL), operative duration, transfusion rates, and VTE incidence.
• Meta-analysis compared outcomes between patients receiving TXA and control groups.

Main Results:

• TXA significantly reduced blood loss in brain tumor resections without increasing VTE or seizure risk (p < 0.001).
• TXA did not demonstrate a significant effect on intraoperative blood loss (IOBL) during spinal tumor surgery (p = 0.66).
• The analysis included 16 eligible studies.

Conclusions:

• TXA is a safe and effective antifibrinolytic agent for reducing blood loss in brain tumor surgery.
• The utility of TXA in spinal tumor resection warrants further investigation.
• This meta-analysis provides a comprehensive overview of TXA's role in CNS tumor surgery.