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A systematic review and meta-analysis of the effects of tranexamic acid in surgical procedure for intracranial meningioma

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Abstract

Purpose

During intracranial meningioma surgery, surgeons experience considerable blood loss. Tranexamic acid (TXA) is used to minimize blood loss in several neurosurgical settings. However, evidence and trials are lacking. Our objective is to establish the most recent evidence on TXA safety and efficacy in intracranial meningioma surgery.

Methodology

Based upon Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors collected fully published English literature on the administration of tranexamic acid for patients undergoing intracranial meningioma surgery using the keywords [“tranexamic acid” and “meningioma”] and its synonyms from Cochrane Central Database, the WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and PubMed. The primary outcome of the current study was total blood loss. The secondary outcomes include individuals requiring blood transfusion, anesthesia duration, surgical duration, and complication rate. Each included studies' quality was assessed using the JADAD scale.

Results

For qualitative and quantitative data synthesis, we included five RCTs (n = 321) with the mean age was 47.5 ± 11.9 years for the intervention group and 47.2 ± 11.9 years for the control group. Our meta-analysis showed that the administration of TXA is associated with decreased total blood loss of standardized mean difference (SMD) of −1.40 (95% CI [−2.49, −0.31]), anesthetic time SMD −0.36 (95% CI [−0.63, −0.09]), and blood transfusion requirements RR 0.58 (95% CI [0.34, 0.99]).

Conclusions

The current study showed that TXA was associated with reduced intraoperative blood loss and intra- and postoperative blood transfusion. However, the studies are small. More RCT studies with a greater sample size are favorable.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

TXA:

Tranexamic acid

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

ICTRP:

International Clinical Trials Registry Platform

RR:

Risk ratio

MD:

Mean difference

CI:

Confidence interval

RCT:

Randomized controlled trial

N:

Number

mL:

Millilitre

min:

Minute

mg:

Milligram

kg:

Kilogram

h:

Hour

NS:

Normal saline

vs:

Versus

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Universitas Pelita Harapan, Tangerang, Banten, Indonesia

    Jeremiah Hilkiah Wijaya & Julius July

  2. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Miguel Quintero-Consuegra

  3. Departement of Neurosurgery, Faculty of Medicine, CES University, El Poblado, Medellín, Antioquia, Colombia

    Daniela Perez Chadid

Authors
  1. Jeremiah Hilkiah Wijaya
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JHW, JJ, MQC, and DPC. The first draft of the manuscript was written by JHW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jeremiah Hilkiah Wijaya.

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Wijaya, J.H., July, J., Quintero-Consuegra, M. et al. A systematic review and meta-analysis of the effects of tranexamic acid in surgical procedure for intracranial meningioma. J Neurooncol 161, 383–393 (2023). https://doi.org/10.1007/s11060-023-04237-2

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