Effect of Low Dose Intraoperative Tranexamic Acid Infusion on Perioperative Blood Loss in Patients Undergoing Craniotomy for Intracranial Neoplasms: A Double Blinded Randomised Control Study

Background: Blood loss is often a major complication of neurosurgery; and adversely impacts postoperative outcomes. Primary objective of our study was to assess the effect of tranexamic acid (TXA) on total perioperative blood loss and the need for packed red blood cell (PRBC) transfusion in patients. Secondary objective was to assess and compare the effect of TXA on haemoglobin (Hb) , packed cell volume (PCV), coagulation profile, crystalloid and PRBC requirement, neurological outcomes; and the quality of surgical field peri-operatively. Materials and Methods: 60 adult patients, undergoing elective craniotomy for tumor resection were recruited. 30 patients each, received either a bolus of TXA , followed by an infusion (TXA group); or normal saline in the same dose (Placebo group). Crystalloid and PRBC transfusion, blood loss, Hb, PCV, platelet count, fibrinogen levels, international normalized ratio were recorded. Mean intensive care unit (ICU) stay and Glasgow Outcome Extended (GOSE) score were also measured. Results: There was no significant difference in blood loss, PRBC requirement, Hb, PCV, fibrinogen levels , INR, duration of ICU stay or the quality of the operative field; between the TXA and placebo groups. GOSE scores were better and platelet count decrease was significantly higher in the TXA group. Conclusion: Low-dose TXA did not significantly reduce blood loss or improve outcomes in patients undergoing intracranial tumor resection. GOSE score was better; and the platelet decrease post- operatively was significantly higher in the TXA group.