Abstract SNACC-62

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The efficacy and safety of tranexamic acid in complex skull base neurosurgical procedures

Flexman A, Mebel D, Akagami R
University of British Columbia, Vancouver, BC, Canada

Background: Complex skull base neurosurgical procedures have the potential for increased intraoperative blood loss compared to other procedures yet coagulation near eloquent cranial structures should be minimized. Tranexamic acid is an effective antifibrinolytic used in other types of surgery to minimize blood loss, yet the safety and efficacy of tranexamic acid in elective neurosurgical procedures is not known. Our primary objective was to determine the relationship between the use of tranexamic acid and blood product transfusion at our institution. Our secondary objective was to determine the incidence of adverse events associated with the use of tranexamic acid.
Methods: In this retrospective cohort study, we included all patients who underwent complex skull base neurosurgical procedures at our institution between 2001 and 2013 by a single surgeon. Tranexamic acid was introduced during these procedures in 2006. Patient and surgical variables, transfusion data and adverse events in the perioperative period were abstracted from the medical record. Rates of transfusion and adverse events were compared between patients who did and did not receive tranexamic acid. All data analysis was done with STATA 12.1 (StataCorp, Texas, USA).
Results: 245 patients who received tranexamic acid were compared to 274 patients who did not receive the drug during the study period. The two groups were similar in terms of age, weight, gender and preoperative haemoglobin however patients who received tranexamic acid had larger tumors (35 vs 29 mm, p<0.001) and longer procedures (432 vs 371 minutes, p<0.001). The rate of transfusion in patients who received tranexamic acid was significantly lower (6.9 vs 12.4%, p=0.037). The rates of thromboembolic events and seizure were similar between the two groups.
Conclusion: Patients who received tranexamic acid during complex skull base neurosurgery in our cohort had a lower rate of transfusion despite having larger intracranial tumors and longer procedures. Our results support the need for future randomized controlled trials to clarify the efficacy of tranexamic acid in neurosurgical procedures.

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