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

In the present study, we review the extant evidentiary base concerning TXA as an antifibrinolytic agent that can decrease blood loss during surgical resection of central nervous system (CNS) neoplasms of the brain and spinal column. Furthermore, we assess the theoretical risk that TXA poses for developing VTEs and weigh these risks against those of allogeneic blood transfusions.

We queried three databases to identify studies presenting primary data on using TXA during surgical resection of CNS neoplasms. Relevant data collected included estimated/intraoperative blood loss (EBL/IOBL), operative duration, transfusion incidence, and rate of venous thromboembolic events (VTEs). Patients who received TXA were compared to controls undergoing surgery for CNS tumors (brain and spine) who did not receive TXA (or any other antifibrinolytics) perioperatively.

Ultimately, 16 studies were deemed eligible for inclusion in the present meta-analysis. In brain tumor surgery, TXA appears to successfully reduce blood loss without predisposing patients to VTE or seizure (p < 0.001). However, when used to manage spinal tumors, TXA does not appear to affect intraoperative blood loss (IOBL) [p = 0.66].

This review serves as the most up-to-date and comprehensive analysis of the use of TXA during the resection of intracranial and spinal tumors. It implies that TXA is both safe and effective in promoting hemostasis during brain tumor surgery. However, its use for resection of spinal tumors remains an area in need of ongoing investigation.