Department of Neurosurgery, University Center UNiAtenas, Paracatu, Minas Gerais, Brazil.
Department of Neurosurgery of FBHC and Neurosurgery Service, Aracaju, Sergipe, Brazil.
Neurosurg Rev. 2021 Jun;44(3):1287-1298. doi: 10.1007/s10143-020-01324-0. Epub 2020 Jun 17.
Tranexamic acid (TXA) is one of the measures indicated to reduce bleeding and the need for volume replacement. However, data on risks and benefits are controversial. This study analyzes the effectivity and risks of using tranexamic acid in neurosurgery. We selected articles, published from 1976 to 2019, on the PubMed, EMBASE, Science Direct, and The Cochrane Database using the descriptors: "tranexamic acid," "neurosurgery," "traumatic brain injury," "subdural hemorrhage," "brain aneurysm," and "subarachnoid hemorrhage." TXA can reduce blood loss and the need for blood transfusion in trauma and spinal surgery. Despite the benefits of TXA, moderate-to-high doses are potentially associated with neurological complications (seizures, transient ischemic attack, delirium) in adults and children. In a ruptured intracranial aneurysm, the use of TXA can considerably reduce the risk of rebleeding, but there is weak evidence regarding its influence on mortality reduction. The TXA use in brain surgery does not present benefit. However, this conclusion is limited because there are few studies. TXA in neurosurgeries is a promising method for the maintenance of hemostasis in affected patients, mainly in traumatic brain injury and spinal surgery; nevertheless, there is lack of evidence in brain and vascular surgeries. Many questions remain unanswered, such as how to determine the dosage that triggers the onset of associated complications, or how to adjust the dose for chronic kidney disease patients.
氨甲环酸（TXA）是减少出血和需要输血的一种措施。然而，关于其风险和获益的数据仍存在争议。本研究分析神经外科中使用氨甲环酸的效果和风险。我们使用 "tranexamic acid"、"neurosurgery"、"traumatic brain injury"、"subdural hemorrhage"、"brain aneurysm" 和 "subarachnoid hemorrhage" 等主题词，从 1976 年到 2019 年，在 PubMed、EMBASE、Science Direct 和 The Cochrane Database 中选择文章。TXA 可减少创伤和脊柱手术中的出血量和输血需求。尽管 TXA 有获益，但中高剂量与成人和儿童的神经并发症（癫痫发作、短暂性脑缺血发作、谵妄）相关。在颅内破裂动脉瘤中，使用 TXA 可显著降低再出血风险，但关于其对死亡率降低的影响的证据较弱。TXA 在脑外科手术中没有获益。然而，由于研究较少，这个结论是有限的。TXA 在神经外科手术中是一种有前途的止血方法，主要适用于创伤性脑损伤和脊柱手术；然而，在脑和血管手术中证据不足。许多问题仍未得到解答，例如如何确定引发相关并发症的剂量，或者如何为慢性肾病患者调整剂量。
