Tranexamic acid in Neurosurgery: a controversy indication-review.
José Luiz de FariaJosué da Silva BritoLouise Teixeira Costa E SilvaChristiano Tadeu Sanches Mattos KilesseNicolli Bellotti de SouzaCarlos Umberto PereiraEberval Gadelha FigueiredoNícollas Nunes RabeloPublished in: Neurosurgical review (2020)
Tranexamic acid (TXA) is one of the measures indicated to reduce bleeding and the need for volume replacement. However, data on risks and benefits are controversial. This study analyzes the effectivity and risks of using tranexamic acid in neurosurgery. We selected articles, published from 1976 to 2019, on the PubMed, EMBASE, Science Direct, and The Cochrane Database using the descriptors: "tranexamic acid," "neurosurgery," "traumatic brain injury," "subdural hemorrhage," "brain aneurysm," and "subarachnoid hemorrhage." TXA can reduce blood loss and the need for blood transfusion in trauma and spinal surgery. Despite the benefits of TXA, moderate-to-high doses are potentially associated with neurological complications (seizures, transient ischemic attack, delirium) in adults and children. In a ruptured intracranial aneurysm, the use of TXA can considerably reduce the risk of rebleeding, but there is weak evidence regarding its influence on mortality reduction. The TXA use in brain surgery does not present benefit. However, this conclusion is limited because there are few studies. TXA in neurosurgeries is a promising method for the maintenance of hemostasis in affected patients, mainly in traumatic brain injury and spinal surgery; nevertheless, there is lack of evidence in brain and vascular surgeries. Many questions remain unanswered, such as how to determine the dosage that triggers the onset of associated complications, or how to adjust the dose for chronic kidney disease patients.
Keyphrases
- end stage renal disease
- chronic kidney disease
- traumatic brain injury
- subarachnoid hemorrhage
- cerebral ischemia
- minimally invasive
- ejection fraction
- peritoneal dialysis
- brain injury
- coronary artery bypass
- white matter
- coronary artery
- emergency department
- risk factors
- spinal cord
- resting state
- young adults
- type diabetes
- cardiovascular disease
- randomized controlled trial
- risk assessment
- functional connectivity
- climate change
- human health
- high intensity
- deep learning
- case control
- cardiovascular events
- hip fracture
- adverse drug