Advertisement
Original Research| Volume 110, P53-60, April 2023

Tranexamic acid use in meningioma surgery – A systematic review and meta-analysis

  • Abigail L. Clynch
    Correspondence
    Corresponding authors at: Biosciences Building, Crown Street, Liverpool L69 7BE, UK.
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
    Search for articles by this author
  • Conor S. Gillespie
    Correspondence
    Corresponding authors at: Biosciences Building, Crown Street, Liverpool L69 7BE, UK.
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • George E. Richardson
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Mohammad A. Mustafa
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Abdurrahman I. Islim
    Affiliations
    Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK

    Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
    Search for articles by this author
  • Sumirat M. Keshwara
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
    Search for articles by this author
  • Ali Bakhsh
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Siddhant Kumar
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Rasheed Zakaria
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Christopher P. Millward
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Samantha J. Mills
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Andrew R. Brodbelt
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author
  • Michael D. Jenkinson
    Affiliations
    Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK

    Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
    Search for articles by this author

      Highlights

      • Tranexamic Acid reduces intraoperative blood loss in meningioma surgery.
      • Tranexamic Acid has no affect on blood transfusion requirement or postoperative outcomes in meningioma surgery.

      Abstract

      Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. The aim of this review was to evaluate the effect of TXA use on intraoperative and postoperative outcomes of meningioma surgery. A systematic review and meta-analysis was conducted in accordance with the PRISMA statement and registered in PROSPERO (CRD42021292157). Six databases were searched up to November 2021 for phase 2–4 control trials or cohort studies, in the English language, examining TXA use during meningioma surgery. Studies ran outside of dedicated neurosurgical departments or centres were excluded. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random effects meta-analysis were performed to delineate differences in operative and postoperative outcomes. Four studies (281 patients) were included. TXA use significantly reduced intraoperative blood loss (mean difference 315.7 mls [95% confidence interval [CI] −532.8, −98.5]). Factors not affected by TXA use were transfusion requirement (odds ratio = 0.52; 95% CI 0.27, 0.98), operation time (mean difference = -0.2 h; 95% CI −0.8, 0.4), postoperative seizures (Odds Ratio [OR] = 0.88; 95% CI 0.31, 2.53), hospital stay (mean difference = -1.2; 95% CI −3.4, 0.9) and disability after surgery (OR = 0.50; 95% CI 0.23, 1.06). The key limitations of this review were the small sample size, limited data for secondary outcomes and a lack of standardised method for measuring blood loss. TXA use reduces blood loss in meningioma surgery, but not transfusion requirement or postoperative complications. Larger trials are required to investigate the impact of TXA on patient-reported postoperative outcomes.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ostrom Q.T.
        • Cioffi G.
        • Waite K.
        • Kruchko C.
        • Barnholtz-Sloan J.S.
        CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014-2018.
        Neuro Oncol. 2021; 23 (PMID: 34608945; PMCID: PMC8491279): iii1-iii105https://doi.org/10.1093/neuonc/noab200
      1. Goldbrunner R, Stavrinou P, Jenkinson MD, Sahm F, Mawrin C, Weber DC, Preusser M, Minniti G, Lund-Johansen M, Lefranc F, Houdart E, Sallabanda K, Le Rhun E, Nieuwenhuizen D, Tabatabai G, Soffietti R, Weller M. EANO guideline on the diagnosis.

        • Bansal S.
        • Pawar P.
        • Sawant A.
        • Tamhankar A.
        • Patil S.
        • Kasat G.
        Predictive factors for fever and sepsis following percutaneous nephrolithotomy: A review of 580 patients.
        Urol Ann. 2017; 9: 230
        • Fathi A.R.
        • Roelcke U.
        Meningioma.
        Curr Neurol Neurosci Rep. 2013; 13: 337
        • McGuire C.
        • Nurmsoo S.
        • Samargandi O.A.
        • Bezuhly M.
        Role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis in primary elective rhinoplasty: A systematic review and meta-analysis.
        JAMA Facial Plast Surg. 2019; 21: 191-198https://doi.org/10.1001/jamafacial.2018.1737. PMID: 30605219; PMCID: PMC6537831
        • Dunn C.J.
        • Goa K.L.
        Tranexamic acid: a review of its use in surgery and other indications.
        Drugs. 1999; 57 (PMID: 10400410): 1005-1032https://doi.org/10.2165/00003495-199957060-00017
        • Neef V.
        • König S.
        • Monden D.
        • Dubinski D.
        • Benesch A.
        • Raimann F.J.
        • et al.
        Clinical outcome and risk factors of red blood cell transfusion in patients undergoing elective primary meningioma resection.
        Cancers (Basel). 2021; 13: 3601https://doi.org/10.3390/cancers13143601. PMID: 34298814; PMCID: PMC8307823
      2. Excellence, N. (2022). TRANEXAMIC ACID | Drug | BNF content published by NICE. Retrieved 5 January 2022, from https://bnf.nice.org.uk/drug/tranexamic-acid.html.

        • Hsu S.-Y.
        • Huang Y.-H.
        Characterization and prognostic implications of significant blood loss during intracranial meningioma surgery.
        Transl Cancer Res. 2016; 5: 797-804
        • Roberts I.
        Tranexamic acid in trauma: how should we use it?.
        J Thromb Haemost. 2015; 13 (PMID: 26149023): S195-S199https://doi.org/10.1111/jth.12878
        • Hooda B.
        • Chouhan R.S.
        • Rath G.P.
        • Bithal P.K.
        • Suri A.
        • Lamsal R.
        Effect of tranexamic acid on intraoperative blood loss and transfusion requirements in patients undergoing excision of intracranial meningioma..
        J Clin Neurosci. 2017; 41 (Epub 2017 Mar 7. PMID: 28283245): 132-138https://doi.org/10.1016/j.jocn.2017.02.053
        • Roberts I.
        • Shakur H.
        • Coats T.
        • Hunt B.
        • Balogun E.
        • Barnetson L.
        • et al.
        The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients.
        Health Technol Assess. 2013 Mar; 17: 1-79https://doi.org/10.3310/hta17100. PMID: 23477634; PMCID: PMC4780956
        • Sethna N.F.
        • Zurakowski D.
        • Brustowicz R.M.
        • Bacsik J.
        • Sullivan L.J.
        • Shapiro F.
        Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery.
        Anesthesiology. 2005; 102 (PMID: 15791100): 727-732https://doi.org/10.1097/00000542-200504000-00006
        • Sprigg N.
        • Flaherty K.
        • Appleton J.P.
        • Salman R.-S.
        • Bereczki D.
        • Beridze M.
        • et al.
        Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial.
        Lancet. 2018; 391: 2107-2115
      3. Ravi GK, Panda N, Ahluwalia J, Chauhan R, Singla N, Mahajan S. Effect of tranexamic acid on blood loss, coagulation profile, and quality of surgical field in intracranial meningioma resection: A prospective randomized, double-blind, placebo-controlled study. Surg Neurol Int. 2021; 12:272. 10.25259/SNI_296_2021. PMID: 34221603; PMCID: PMC8247710.

      4. Rebai L, Mahfoudhi N, Fitouhi N, Daghmouri MA, Bahri K. Intraoperative tranexamic acid use in patients undergoing excision of intracranial meningioma: Randomized, placebo-controlled trial. Surg Neurol Int. 2021; 12:289. 10.25259/SNI_177_2021. PMID: 34221620; PMCID: PMC8247750.

        • Siddiqui A.K.
        • Raman R.
        • Arshad Z.
        • Hemlata S.V.
        • Hashmi A.S.
        Use of Tranexamic Acid to reduce intraoperative bleeding in craniotomy for Meningioma pateints.
        Asian Arch Anaesthesiol Resuscitat. 2017;
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • Boutron I.
        • Hoffmann T.C.
        • Mulrow C.D.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 29n71https://doi.org/10.1136/bmj.n71. PMID: 33782057; PMCID: PMC8005924
        • Ouzzani M.
        • Hammady H.
        • Fedorowicz Z.
        • Elmagarmid A.
        Rayyan — a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210https://doi.org/10.1186/s13643-016-0384-4
      5. Deeks J, Higgins J. Statistical algorithms in review manager 5. 2010 Aug. https://training.cochrane.org/handbook/statistical-methods-revman5.

      6. Higgins J P T, Altman D G, Gøtzsche P C, Jüni P, Moher D, Oxman A D et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials BMJ 2011; 343 :d5928 doi:10.1136/bmj.d5928.

        • Ker K.
        • Edwards P.
        • Perel P.
        • Shakur H.
        • Roberts I.
        Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis..
        BMJ. 2012; 344 (PMID: 22611164; PMCID: PMC3356857): e3054https://doi.org/10.1136/bmj.e3054
        • Rawn J.
        The silent risks of blood transfusion.
        Curr Opin Anaesthesiol. 2008; 21 (PMID: 18784496): 664-668https://doi.org/10.1097/ACO.0b013e32830f1fd1
        • van den Akker T.A.
        • Grimes Z.M.
        • Friedman M.T.
        Transfusion-associated circulatory overload and transfusion-related acute lung injury.
        Am J Clin Pathol. 2021; 156 (PMID: 33822854): 529-539https://doi.org/10.1093/ajcp/aqaa279
        • Shah A.
        • Palmer A.J.R.
        • Klein A.A.
        Strategies to minimize intraoperative blood loss during major surgery.
        Br J Surg. 2020 Jan; 107 (PMID: 31903592): e26-e38https://doi.org/10.1002/bjs.11393
        • McClelland 3rd, S.
        • Hall W.A.
        Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures.
        Clin Infect Dis. 2007; 45 (Epub 2007 May 21 PMID: 17554701): 55-59https://doi.org/10.1086/518580
        • Patir R.
        • Mahapatra A.K.
        • Banerji A.K.
        Risk factors in postoperative neurosurgical infection.
        A prospective study Acta Neurochir (Wien). 1992; 119 (PMID: 1481758): 80-84https://doi.org/10.1007/BF01541786
      7. Tranexamic acid and thrombosis. Prescrire Int. 2013 Jul;22(140):182-3. PMID: 23951593.

        • Wrenn S.M.
        • Cepeda-Benito A.
        • Ramos-Valadez D.I.
        • Cataldo P.A.
        Patient perceptions and quality of life after colon and rectal surgery: what do patients really want?.
        Dis Colon Rectum. 2018; 61: 971-978https://doi.org/10.1097/DCR.0000000000001078. PMID: 29944576. = 33, 33
      8. The COSMIC Project. COMET registration No.1508, accessible at https://comet-initiative.org/Studies/Details/1508 . This study has University of Liverpool sponsorship and ethical approval (Ref UoL001601) – 34. Date last accessed 01/06/2022.

        • Nowicki P.D.
        • Ndika A.
        • Kemppainen J.
        • Cassidy J.
        • Forness M.
        • Satish S.
        • et al.
        Measurement of intraoperative blood loss in pediatric orthopaedic patients: evaluation of a new method.
        J Am Acad Orthop Surg Glob Res Rev. 2018; 2: e014
      9. World Health Organization & WHO Patient Safety. (2008). Implementation manual: WHO surgical safety checklist (first edition). World Health Organization. https://apps.who.int/iris/handle/10665/70046.

        • Brecher M.E.
        • Monk T.
        • Goodnough L.T.
        A standardized method for calculating blood loss.
        Transfusion. 1997; 37 (PMID: 9354828): 1070-1074https://doi.org/10.1046/j.1537-2995.1997.371098016448.x