Effect of tranexamic acid on blood loss in patients undergoing resection of large meningioma: a randomized clinical trial

To determine whether intraoperative tranexamic acid (TXA) administration reduced intraoperative blood loss in patients undergoing large meningioma resection. Patients undergoing large meningioma resection face a high risk of significant blood loss. While TXA reduces blood loss and transfusion requirements in many non-neurosurgical procedures, its effect on patients undergoing supratentorial large meningioma resection remains unclear. This study was a single-center randomized double-blind trial. 228 patients having elective resections of supratentorial meningiomas with diameters ≥ 5 cm were enrolled between February 2022 and January 2024. Patients were randomly assigned 1:1:1 to high-dose TXA (20 mg/kg followed by a continuous infusion of 5 mg/kg/h), low-dose TXA (a single bolus of 20 mg/kg), or saline placebo. Anesthesiologists, neurosurgeons, and outcome assessors were all fully blinded to treatment. Our primary outcome was clinically estimated blood loss. Between February 2022 and January 2024, a total of 228 patients were randomized. The baseline was similar in each group. Median estimated blood loss was 400mL (interquartile range (IQR), 200 to 775 mL) with high-dose TXA, 425 mL (IQR, 220 to 1000 mL) with low-dose TXA, and 400 mL (IQR, 220 to 1000 mL) in the placebo group (P = 0.875). Other secondary outcomes did not differ significantly from any pairs of treatment groups. Intraoperative TXA administration was not associated with a statistically significant reduction in intraoperative blood loss or transfusion requirements in patients undergoing resection of large supratentorial meningiomas. Trial registration: ClinicalTrials.gov identifier NCT05230381.