Case studyEffect of tranexamic acid on intraoperative blood loss and transfusion requirements in patients undergoing excision of intracranial meningioma

•Surgical excision of intracranial meningioma is often complicated by significant blood loss.•Use of tranexamic acid reduces perioperative blood loss, but its effect is uncertain during neurosurgery.•Sixty adult patients undergoing elective craniotomy for meningioma excision were randomized to receive either tranexamic acid or placebo (Normal saline).•Intraoperative blood loss and transfusion requirements, estimation surgical hemostasis using a 5-grade hemostasis scale were recorded.•Administration of tranexamic acid reduced blood loss significantly.•Surgical field hemostasis was better achieved in patients who received tranexamic acid.

Surgical excision of meningioma is often complicated by significant blood loss requiring blood transfusion with its attendant risks. Although tranexamic acid is used to reduce perioperative blood loss, its blood conservation effect is uncertain in neurosurgery. Sixty adults undergoing elective craniotomy for meningioma excision were randomized to receive either tranexamic acid or placebo, initiated prior to skin incision. Patients in the tranexamic acid group received intravenous bolus of 20 mg/kg over 20 min followed by an infusion of 1 mg/kg/h till the conclusion of surgery. Intraoperative blood loss, transfusion requirements and estimation of surgical hemostasis using a 5-grade scale were noted. Postoperatively, the extent of tumor excision on CT scan and complications were observed. Demographics, tumor characteristics, amount of fluid infusion, and duration of surgery and anesthesia were comparable between the two groups. The amount of blood loss was significantly less in tranexamic acid group compared to placebo (830 ml vs 1124 ml; p = 0.03). The transfusion requirement was less in tranexamic acid group (p > 0.05). The patients in tranexamic acid group fared better on a 5-grade surgical hemostasis scale with more patients showing good hemostasis (p = 0.007). There were no significant differences between the groups with regards to extent of tumor removal, perioperative complications, hospital stay or neurologic outcome. To conclude, administration of tranexamic acid significantly reduced blood loss in patients undergoing excision of meningioma. Fewer patients in the tranexamic acid group received blood transfusions. Surgical field hemostasis was better achieved in patients who received tranexamic acid.