Effect of tranexamic acid on blood loss and the quality of surgical field in meningioma resection surgery

Background: Resection of brain tumours has been associated with increased blood loss and blood transfusion. Achieving proper haemostasis forms one of the most important intraoperative goals in such surgeries. Tranexamic acid has been used to reduce blood loss in various settings, but its efficacy and use in neurosurgery is very limited. The purpose of this randomised, double-blinded, placebo-controlled, parallel trial was to evaluate the efficacy of Tranexamic acid on blood loss and quality of surgical field in meningioma resection surgeries. Materials and Methods: 30 patients, aged 18–65 years undergoing elective meningioma resection surgeries were included in the study. They received either Tranexamic acid or placebo at a loading dose of 25 mg/kg and infusion of 1 mg/kg/hr during surgery. The intraoperative blood loss was measured. The surgical field was assessed by the surgeon using 5-point Likert scale. Results: The patients who received Tranexamic acid had significantly less blood loss compared to the placebo group (616.42 ± 393.42 vs 1150.02 ± 416.1, P = 0.02), which accounted for 46.43% reduction in blood loss. It also reduces the intraoperative blood transfusion requirement (0 vs 6, P = 0.0016). The quality of the surgical field was significantly better in the Tranexamic acid group with a median score 4 compared to 2 in placebo group (P < 0.001). The blood collected in closed suction drain 24 hours post surgery was less in the Tranexamic acid group compared to placebo group (84.7 + 50.4 vs 127.6 + 62.2, P = 0.047). Conclusion: Tranexamic acid reduces perioperative blood loss and transfusion requirement with improved surgical field in patients undergoing meningioma resection surgeries.