Abstract：
The cautionary stance normally taken towards tranexamic acid (TXA) is rooted in concerns regarding its complication profile, namely its purported risk for venous thromboembolic events (VTEs). In the present review, we intend to bring increased attention to TXA as a remarkably valuable tool that does not appear to increase the risk for VTE when used as indicated in select patients.
We queried three databases to identify reporting use of TXA during nontraumatic cranial neurosurgery procedures (excluded traumatic brain injury). Data gathered included VTE complications, deep venous thrombosis, use of allogeneic blood transfusions, estimated blood loss, and operative duration.
Twenty-eight studies were deemed eligible for inclusion in the present meta-analysis, including nine studies on surgical resection of intracranial neoplasms, ten studies on aneurysmal subarachnoid hemorrhage, and nine studies on craniosynostosis. In brain tumor surgery, TXA appears to successfully reduce blood loss without predisposing patients to VTE or seizure (P < 0.01). However, it does not appear to reduce rates of vasospasm in aneurysmal subarachnoid hemorrhage (P = 0.27), and its administration is not associated with clinically meaningful differences in long term neurological outcomes. For pediatric patients undergoing craniosynostosis procedures, TXA similarly reduces blood loss (P < 0.01). Nonetheless, low dosing protocols should be used because they appear effective and the effects of high dose TXA in children have not been studied.
TXA is an effective hemostatic agent that can be administered to reduce blood loss and transfusion requirements for a wide range of neurosurgical applications in a broad spectrum of patient populations.
We queried three databases to identify reporting use of TXA during nontraumatic cranial neurosurgery procedures (excluded traumatic brain injury). Data gathered included VTE complications, deep venous thrombosis, use of allogeneic blood transfusions, estimated blood loss, and operative duration.
Twenty-eight studies were deemed eligible for inclusion in the present meta-analysis, including nine studies on surgical resection of intracranial neoplasms, ten studies on aneurysmal subarachnoid hemorrhage, and nine studies on craniosynostosis. In brain tumor surgery, TXA appears to successfully reduce blood loss without predisposing patients to VTE or seizure (P < 0.01). However, it does not appear to reduce rates of vasospasm in aneurysmal subarachnoid hemorrhage (P = 0.27), and its administration is not associated with clinically meaningful differences in long term neurological outcomes. For pediatric patients undergoing craniosynostosis procedures, TXA similarly reduces blood loss (P < 0.01). Nonetheless, low dosing protocols should be used because they appear effective and the effects of high dose TXA in children have not been studied.
TXA is an effective hemostatic agent that can be administered to reduce blood loss and transfusion requirements for a wide range of neurosurgical applications in a broad spectrum of patient populations.
摘要：
背景：通常对TXA采取的警告立场源于对其并发症情况的担忧，即其所谓的静脉血栓栓塞事件（VTE）的风险。在本次审查中，我们打算增加对TXA的关注,TXA是一种非常有价值的工具,在部分患者中使用时,它似乎不会增加VTE的风险.
方法：我们查询了三个数据库，以确定在非创伤性颅神经外科手术（TBI除外）期间使用TXA的报告。收集的数据包括静脉血栓栓塞并发症（VTE），深静脉血栓形成(DVT),使用同种异体输血，估计失血量（EBL），和手术持续时间。
结果：28项研究被认为符合纳入本荟萃分析的条件，包括九项关于颅内肿瘤手术切除的研究，关于aSAH的十项研究，和九项关于颅骨融合的研究。在脑瘤手术中，TXA似乎可以成功减少失血，而不会使患者诱发VTE或癫痫发作（p<0.01）。然而,它似乎不会降低aSAH的血管痉挛率（p=0.27），并且其给药与长期神经系统结局的临床意义差异无关.对于接受颅骨融合手术的儿科患者，TXA类似地减少失血(p<0.01)。尽管如此，应该使用低剂量方案，因为它们似乎有效，并且尚未研究高剂量TXA对儿童的影响。
结论：TXA是一种有效的止血剂，可用于减少失血量和输血需求，适用于广泛的神经外科应用。
方法：我们查询了三个数据库，以确定在非创伤性颅神经外科手术（TBI除外）期间使用TXA的报告。收集的数据包括静脉血栓栓塞并发症（VTE），深静脉血栓形成(DVT),使用同种异体输血，估计失血量（EBL），和手术持续时间。
结果：28项研究被认为符合纳入本荟萃分析的条件，包括九项关于颅内肿瘤手术切除的研究，关于aSAH的十项研究，和九项关于颅骨融合的研究。在脑瘤手术中，TXA似乎可以成功减少失血，而不会使患者诱发VTE或癫痫发作（p<0.01）。然而,它似乎不会降低aSAH的血管痉挛率（p=0.27），并且其给药与长期神经系统结局的临床意义差异无关.对于接受颅骨融合手术的儿科患者，TXA类似地减少失血(p<0.01)。尽管如此，应该使用低剂量方案，因为它们似乎有效，并且尚未研究高剂量TXA对儿童的影响。
结论：TXA是一种有效的止血剂，可用于减少失血量和输血需求，适用于广泛的神经外科应用。
