Efficacy, safety and dose patterns of tranexamic acid in meningioma surgery: a systematic review and updated meta-analysis of randomized controlled trials

We reviewed the efficacy and safety of intravenous administration of tranexamic acid (TXA) in randomized trials involving patients undergoing intracranial meningioma resection surgery, with special emphasis on the effects of different dosages. A comprehensive search was conducted in the following databases: Cochrane, PubMed, Embase, Scopus, Lilacs, and Web of Science. Two reviewers independently screened titles and abstracts, reviewed the full texts and collected data. Efficacy outcomes analyzed included intraoperative blood loss, blood transfusion rate, duration of surgery, and length of hospital stay. The safety outcomes evaluated included postoperative complications such as seizures, thromboembolic events, and hematoma. A subgroup analysis was performed based on the dosage and timing of administration. Six randomized controlled trials (RCTs) were included, covering 881 patients. Meta-analysis of the data demonstrated that the use of TXA resulted in a significant reduction in intraoperative blood loss (Mean Difference [MD] = -270.26 ml, 95% CI [-422.84, -117.67], p < 0.01, I² = 99%), blood transfusion rate (Relative Risk [RR] = 0.60, 95% CI: [0.46, 0.78], p < 0.01, I² = 3%), duration of surgery (MD = -19.76 min, 95% CI: [-41.74, 2.23], p < 0.01, I² = 75%), and length of hospital stay (MD: -0.48 days, 95% CI: [-0.93, -0.04], p < 0.01, I² = 32%). No significant differences were found in the postoperative complications assessed. In the dosage analysis, the preoperative 20 mg/kg regimen, along with the intraoperative maintenance dose of 1 mg/kg/h, was more effective in reducing intraoperative blood loss in the TXA group, although not statistically significant (323.64 ml vs. 145.54 ml, p = 0.29). The administration of TXA in patients undergoing intracranial meningioma resection surgery showed beneficial results in all efficacy outcomes evaluated, without increasing postoperative complications. However, further studies, especially multicenter ones, are needed to confirm our results.