Tranexamic Acid Reduce Blood Loss in Meningioma Resection

Effect of Tranexamic Acid Infusion to Reduce Intraoperative Blood Loss in Large Meningioma: A Prospective Randomized Double-blind Control Study

In neurosurgical setting, a large sample size trials of tranexamic acid (TXA) has been limited to TBI and SAH. The evidence of TXA in brain tumor was scarce. A few case reports support the role of TXA in brain tumor patients with significant intraoperative bleeding and difficult achieving hemostasis. To prove the benefit of TXA for an attenuation of blood loss in brain tumor patients, research with a larger sample size is required. This prospective, randomized double-blind controlled study will be conducted to evaluate the effect of TXA in reducing blood loss and blood transfusion in patients with intracranial meningiomas, diameter > 5 cm in at least 2 dimensions from the latest radiographic findings.

Background and Literature review: Meningioma Coagulation in craniotomy to remove meningioma Bleeding in craniotomy to remove meningioma Tranexamic acid (TXA) Knowledge gap The topics shown above has been reviewed to conduct a prospective randomized double-blind, placebo controlled study. To prove the study hypothesis: Will intraoperative TXA administration in adult patients scheduled for craniotomy to remove large meningioma decrease blood loss?

The patients and outcome assessors are blinded to the drug that will be prepared by a pharmacist in the similar unlabelled 50-ml syringe.

Each ampule contains TXA 250 mg. TXA preparation is 2000 mg dilute in normal saline 50 ml to get the concentration of 40 mg/ml. TXA will be administered 20 mg/kg loading over 20 min before skin incision followed by a maintenance infusion of 0.025 ml/kg/h (1 mg/kg/h) until the end of operation.

volume of blood presented in the suction bottle subtracted by the amount of water that the surgeon used in the surgical field the blood from the dry (30 ml) and wet swab (50 ml) serial Hgb / Hct periodically during surgery and compare to those obtain before surgery

The surgeon will be informed about a Likert-type scale which is designed for clinical studies. The surgeon's satisfaction on hemostatic scale is a 3-graded scale modified from 5-graded validated bleeding severity scale. The original version is shown in the table 1. The surgeon will judge his satisfaction on hemostatic quality based on the most critical period or the overview of the surgical procedure. Even the long operative time, there will be one rate represent surgeon's opinion on hemostatic quality.

bleeding, remarkable brain edema, re-craniotomy within 24 hours, worsening GCS, DIC, thromboembolic events, postoperative seizures

Inclusion Criteria: The patients whose aged 18 to 60 years The patients who was diagnosed intracranial meningioma The radio-graphic finding of tumor diameter > 5 cm in at least 2 dimensions The patients have written informed consent The patients is scheduled for elective craniotomy to remove tumor Exclusion Criteria: Patients who refuse to participate in this study Patients with recurrent tumor The patient is set operation for intracranial tissue biopsy The patients with history of TXA allergy The pregnant patients The patients with history of significant thromboembolic episode The patients with significant renal dysfunction (GFR ≤ 50 ml/min)

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