Comparing Two Tranexamic Acid Dosing Regimens for Blood Loss Reduction in Supratentorial Brain Tumor Surgery: A Multicenter, Double-Blind, Randomized Trial

Résumé fourni par la source

Background: The optimal dosing regimen of tranexamic acid (TXA) for minimizing blood loss during supratentorial brain tumor resection remains undefined. This study compared two dosing protocols to evaluate efficacy and safety. Methods: In this double-blind, randomized trial (September 2020–September 2021), 60 patients aged 18–60 years undergoing supratentorial tumor surgery were allocated to receive either TXA1 (20 mg/kg bolus + 1 mg/kg/h infusion) or TXA3 (20 mg/kg bolus + 3 mg/kg/h infusion). Primary outcomes included intraoperative blood loss; secondary outcomes encompassed transfusion needs, surgical duration, hospitalization length, and thromboembolic complications. Results: The TXA3 group demonstrated an 18% reduction in mean intraoperative blood loss compared to TXA1 (402.93 mL vs. 470.61 mL; mean difference −67.68 mL, 95% CI −139.4 to 3.9; p = 0.053). Transfusion requirements were lower in the TXA3 cohort (0.43 ± 0.9 vs. 0.64 ± 1.2 units; p = 0.34), though not statistically significant. Surgical duration was prolonged in the TXA3 group (p = 0.047), but hospitalization was shorter (p = 0.049). Thromboembolic event rates were comparable between groups (p > 0.05). Conclusion: Higher intraoperative TXA infusion rates were associated with reduced blood loss and shorter hospital stays without elevating thromboembolic risk. These findings support TXA’s utility in improving perioperative outcomes and resource efficiency for supratentorial tumor resection.

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