Perioperative Tranexamic Acid and Intraoperative Blood Loss in Convexity and Spheno-Orbital Meningioma Resection: A Double-Blind Randomized Placebo-Controlled Trial

Abstract

Background: Resection of convexity and spheno-orbital meningiomas can cause substantial bleeding. Trials of tranexamic acid (TXA) in meningioma surgery disagree, and indexed evidence from Indonesia, where most patients are women with skull-base tumors, is lacking.

Objective: To determine whether perioperative TXA reduces intraoperative blood loss during resection of convexity and spheno-orbital meningiomas.

Methods: In this single-center, double-blind, placebo-controlled trial at a tertiary hospital in Palembang (January–December 2024), 30 adults were randomized to TXA (15 mg/kg bolus, then 1 mg/kg/h to dural closure) or saline. The primary outcome was intraoperative blood loss. Location-adjusted and baseline-adjusted estimates were evaluated over all datasets compatible with the group summaries.

Results: All 30 patients, all women, were analyzed. Blood loss was 765.0 mL (SD 94.4) with TXA and 1010.0 mL (SD 131.2) with placebo (difference −245.0 mL; 95% CI −330.5 to −159.5; p < 0.001), and the reduction persisted in every location-adjusted configuration (−322.1 to −167.9 mL). Twenty-four-hour D-dimer was lower with TXA (850 vs 1620 ng/mL; p < 0.001), and hemoglobin fell less (−0.97 vs −2.36 g/dL; p = 0.010; Holm-adjusted p = 0.055). Transfusion was required in 73.3% vs 86.7% (risk difference −13.3 points; 95% CI −40.4 to 15.8). No thromboembolic event occurred (0/15 per arm; risk difference 95% CI −20.4 to 20.4 points).

Conclusion: Perioperative TXA reduced blood loss and suppressed fibrinolysis during convexity and spheno-orbital meningioma resection; the smaller hemoglobin fall was supportive. The trial was too small to establish effects on transfusion or thromboembolic safety, which require multicenter trials.