Comparing the safety and efficacy of low-dose versus high-dose tranexamic acid in reducing blood loss in neurosurgical procedures: A systematic review and meta-analysis.
9 affiliations
- 1College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
- 2Department of Surgery, Jazan University, Jazan, Saudi Arabia.
- 3College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
- 4Department of Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India.
- 5Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
- 6Department of Neurosurgery, King Fahd Medical City, Riyadh, Saudi Arabia.
- 7Department of Neurosurgery, Ad Diriyah Hospital, Riyadh, Saudi Arabia.
- 8Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
- 9Department of Neurosurgery, King Salman bin Abdulaziz Medical City, Madinah, Saudi Arabia.
Abstract
Background
Perioperative bleeding is a major concern in neurosurgery, including spine fusions and cranial tumor resections. Tranexamic acid (TXA) is commonly used to reduce blood loss, but the ideal dosing strategy remains controversial. High-dose TXA regimens may enhance hemostasis but raise safety concerns, whereas low-dose regimens are commonly used with unclear comparative efficacy. This review aimed to compare the safety and efficacy of low-dose versus high-dose TXA in neurosurgical procedures.Methods
A comprehensive search of PubMed, Web of Science, and Google Scholar through January 2026 identified studies comparing TXA dosing in neurosurgery. Randomized controlled trials (RCTs) and observational studies reporting at least one relevant outcome were included.Results
Intraoperative blood loss is the primary outcome. Moreover, total blood loss, length of hospital stay, and duration of the surgery were secondary outcomes. The quality of the included studies was assessed using risk of bias 2 for RCTs and Methodological Index for Non-Randomized Studies for non-randomized studies. Meta-analysis was performed where appropriate. Eleven studies met inclusion criteria, with seven included in quantitative synthesis. Both low- and high-dose TXA significantly reduced perioperative blood loss compared with no TXA. However, no statistically significant differences were observed across the outcomes. No increase in thromboembolic events, seizures, or other major complications was observed with high-dose TXA.Conclusion
Both dosing strategies of TXA reduced blood loss effectively. Current evidence does not demonstrate a clear advantage of high-dose over low-dose TXA. However, given the limited direct comparative evidence, further high-quality randomized trials are needed to define the optimal dosing strategy.
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BibTeX
@article{alqarni2026comparing,
title = {{Comparing the safety and efficacy of low-dose versus high-dose tranexamic acid in reducing blood loss in neurosurgical procedures: A systematic review and meta-analysis.}},
author = {Gutaybah S Alqarni and Maryam Alamer and Khloud Ahmad Ywsef and Mohammed N Faleh and Shree Rath and Danisha Kumar and Ohud Alharbi and Mohammed Alharbi and Mubarak Aldawlan and Abdullah Abdulaziz Alhussein and Bassem Yousef Sheikh},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_692_2026},
url = {https://europepmc.org/article/MED/42974572},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Comparing the safety and efficacy of low-dose versus high-dose tranexamic acid in reducing blood loss in neurosurgical procedures: A systematic review and meta-analysis.
AU - Gutaybah S Alqarni
AU - Maryam Alamer
AU - Khloud Ahmad Ywsef
AU - Mohammed N Faleh
AU - Shree Rath
AU - Danisha Kumar
AU - Ohud Alharbi
AU - Mohammed Alharbi
AU - Mubarak Aldawlan
AU - Abdullah Abdulaziz Alhussein
AU - Bassem Yousef Sheikh
PY - 2026
DA - 2026/10/23
JO - Surgical neurology international
DO - 10.25259/sni_692_2026
UR - https://europepmc.org/article/MED/42974572
AB - Background Perioperative bleeding is a major concern in neurosurgery, including spine fusions and cranial tumor resections. Tranexamic acid (TXA) is commonly used to reduce blood loss, but the ideal dosing strategy remains controversial. High-dose TXA regimens may enhance hemostasis but raise safety concerns, whereas low-dose regimens are commonly used with unclear comparative efficacy. This review aimed to compare the safety and efficacy of low-dose versus high-dose TXA in neurosurgical procedures.Methods A comprehensive search of PubMed, Web of Science, and Google Scholar through January 2026 identified studies comparing TXA dosing in neurosurgery. Randomized controlled trials (RCTs) and observational studies reporting at least one relevant outcome were included.Results Intraoperative blood loss is the primary outcome. Moreover, total blood loss, length of hospital stay, and duration of the surgery were secondary outcomes. The quality of the included studies was assessed using risk of bias 2 for RCTs and Methodological Index for Non-Randomized Studies for non-randomized studies. Meta-analysis was performed where appropriate. Eleven studies met inclusion criteria, with seven included in quantitative synthesis. Both low- and high-dose TXA significantly reduced perioperative blood loss compared with no TXA. However, no statistically significant differences were observed across the outcomes. No increase in thromboembolic events, seizures, or other major complications was observed with high-dose TXA.Conclusion Both dosing strategies of TXA reduced blood loss effectively. Current evidence does not demonstrate a clear advantage of high-dose over low-dose TXA. However, given the limited direct comparative evidence, further high-quality randomized trials are needed to define the optimal dosing strategy.
SN - 2229-5097
SN - 2152-7806
ER -