Nguyen Andrew, Brown Nolan J, Gendreau Julian, Nguyen Brandon A, Pennington Zach, Zhang Angie, Harris Mark H, Chakravarti Sachiv, Douse Dontre' M, Van Gompel Jamie J
1Department of Neurological Surgery, University of Florida School of Medicine, Gainesville, Florida.
2Department of Neurological Surgery, University of California, Irvine, Orange, California.
J Neurosurg. 2023 Oct 6;140(4):1008-1018. doi: 10.3171/2023.7.JNS23849. Print 2024 Apr 1.
Antifibrinolytics, such as tranexamic acid (TXA), have been shown to decrease intraoperative blood loss across multiple surgical disciplines. However, they carry the theoretical risk of thromboembolic events secondary to induced hypercoagulability. Therefore, the aim of this study was to systematically review the available literature and perform a meta-analysis on the use of TXA in meningioma resection to assess thromboembolic risks.
The PubMed, Web of Science, and Google Scholar databases were reviewed for all randomized controlled trials presenting primary data on TXA use during resection of intracranial meningiomas. Data were gathered on operative duration, venous thromboembolic complications, deep venous thrombosis, use of allogeneic blood transfusion, estimated blood loss (EBL), and postoperative hemoglobin. Patients who received TXA were compared with controls who did not receive TXA intraoperatively using random-effects models.
A total of 508 unique articles were identified, of which 493 underwent full-text review. Ultimately, 6 studies with 381 total patients (190 receiving TXA) were included in the final analysis. All 6 trials were randomized, blinded, and placebo controlled with a TXA administration rate of a 20-mg/kg load followed by a 1-mg/kg/hr infusion. All studies were performed in lower-middle-income countries. There were no reported instances of venous thromboembolism (VTE) in the TXA and non-TXA cohorts. Patients receiving TXA exhibited fewer allogeneic transfusions (21.5% vs 41.6% [OR 0.26, 95% CI 0.09-0.77], p = 0.02) and lower EBL (MD -282.48 mL [95% CI -367.77 to -197.20 mL], p < 0.001) compared with patients who did not receive TXA, and they also had lower rates of perioperative complications (10.7% vs 19.9% [OR 0.47, 95% CI 0.2-0.95], p = 0.04).
Current literature suggests that TXA is not associated with increased risk for VTE when administered during resection of intracranial meningioma. TXA appears to decrease intraoperative blood loss and allogeneic transfusion requirements during meningioma resection and thus may improve the safety of surgical management of this pathology.
抗纤溶药物，如氨甲环酸（TXA），已被证明可减少多个外科领域的术中失血。然而，它们存在因诱导血液高凝状态而继发血栓栓塞事件的理论风险。因此，本研究的目的是系统回顾现有文献，并对TXA在脑膜瘤切除术中的应用进行荟萃分析，以评估血栓栓塞风险。
检索PubMed、科学网和谷歌学术数据库，查找所有关于颅内脑膜瘤切除术中使用TXA的主要数据的随机对照试验。收集手术持续时间、静脉血栓栓塞并发症、深静脉血栓形成、异体输血使用情况、估计失血量（EBL）和术后血红蛋白的数据。使用随机效应模型，将接受TXA的患者与术中未接受TXA的对照组进行比较。
共识别出508篇独特文章，其中493篇进行了全文审查。最终，6项研究共381例患者（190例接受TXA）纳入最终分析。所有6项试验均为随机、双盲和安慰剂对照，TXA给药率为负荷剂量20mg/kg，随后以1mg/kg/小时输注。所有研究均在中低收入国家进行。TXA组和非TXA组均未报告静脉血栓栓塞（VTE）病例。与未接受TXA的患者相比，接受TXA的患者异体输血较少（21.5%对41.6%[OR 0.26，95%CI 0.09 - 0.77]，p = 0.02），EBL较低（MD - 282.48 mL[95%CI - 367.77至 - 197.20 mL]，p < 0.001），围手术期并发症发生率也较低（10.7%对19.9%[OR 0.47，95%CI 0.2 - 0.95]，p = 0.04）。
当前文献表明，在颅内脑膜瘤切除术中使用TXA与VTE风险增加无关。TXA似乎可减少脑膜瘤切除术中的术中失血和异体输血需求，从而可能提高这种疾病手术治疗的安全性。
