The Effects of Intraoperative Tranexamic Acid on Perioperative Bleeding In Craniotomies

Excessive blood loss during and after a neurosurgical procedure may increase illness and cause death. The surgeons and their team put in a lot of effort during surgery to and prevent excessive bleeding during and after surgery. One of the medications that may help is tranexamic acid (TXA). TXA is a medication that is widely used in cardiac, orthopedic and trauma surgery to prevent heavy bleeding, the need for blood transfusion and reduce death. During neurosurgery, there is not enough proof whether giving TXA to participants reduces blood loss, and there are no clear guidelines regarding the use of TXA. Investigators are interested in studying the effect of TXA on blood loss in participants undergoing craniotomy to remove a brain tumor. A craniotomy is an operation where a piece of the skull is removed to show part of the brain to remove a brain tumor. One of the risks associated with this procedure is bleeding. Currently, some participants undergoing this type of surgery receive TXA and others do not, as the decision to administer TXA is based on an investigator's preference. Therefore, a study investigating the impact of TXA on bleeding during or following craniotomy, as well as its safety, is needed to better inform practice and potentially improve outcomes of surgery.

Inclusion criteria

are the following:

• Adult male or female, between 18-80 years of age.
• Patients are scheduled to undergo a craniotomy for tumor resection.
• Patients/ Substitute Decision Maker have given written consent to participate.

Exclusion criteria

are the following: Patients who meet any of the following exclusion criteria will not be eligible.

• Patients with known active or previous history of thromboembolic disease or deep venous thrombosis.
• Patients with known pre-existing coagulopathy such as hemophilia, Von Willebrand disease, and clotting factor deficiencies.
• Patients with renal impairment and eGFR <60 ml/min/1.73 m2 as determined by the lab or calculated by using the Cockcroft Gault formula or end stage renal disease currently on dialysis.
• Female subjects who are pregnant or currently breastfeeding.
• Patients with Class 3 (high-risk) obesity BMI ≥ to 40.
• Patients undergoing emergency craniotomy or mini craniotomy or craniectomies.
• Patients who received embolization prior to surgery.