Pengaruh Asam Traneksamat Intravena terhadap Jumlah Perdarahan Intraoperatif dan Kebutuhan Transfusi pada Operasi Meningioma

Abstract

Latar Belakang dan Tujuan: Meningioma merupakan tumor otak yang berisiko tinggi terjadi perdarahan pada reseksi massa. Penelitian dengan rancangan double blind RCT dilakukan pada 40 subjek meningioma di RSUP Dr Hasan Sadikin Bandung dengan tujuan melihat pengaruh asam traneksamat (TXA) dalam mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi.
Subjek dan Metode: Subjek penelitian dibagi dua kelompok, kelompok A diberikan asam traneksamat intravena 20 mg/kg dalam NaCl 0,9% 100 mL dan kelompok B diberikan NaCl 0,9% 100 mL sebelum insisi. Data hemodinamik, jumlah cairan, jumlah transfusi dan jumlah perdarahan intraoperatif dicatat per jam. Dilakukan pemeriksaan kadar Hb, Ht dan faktor pembekuan pascaoperasi dan 24 jam pascaoperasi. Data hasil penelitian diuji secara statistik menggunakan uji t tidak berpasangan dan uji Mann-Whitney.
Hasil: Perdarahan intraoperatif (1008,51±327,192 vs 1347±539,120 ml; p=0,021), kebutuhan pada transfusi packed red cell (PRC) intraoperatif (89,30±152,970 ml vs 306,85±224,631 ml; p=0,003), kebutuhan transfusi PRC 24 jam pasca operasi (88,50±153,014 ml vs 212,00±212,505 ml; p=0,028) pada kelompok A secara signifikan lebih kecil dari kelompok B.
Simpulan: Asam traneksamat 20 mg/kg yang diberikan intravena sebelum insisi dapat mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi pada operasi tumor otak suspek meningioma.

Effects of Intravenous Tranexamic Acid on Blood Loss and Transfusion Requirements in Tumor Removal Surgery of Suspected Meningioma

Background and objective: Meningiomas are highly vascular brain neoplasms that often associated with substantial blood loss. This experimental, double-blind RCT conducted in Dr. Hasan Sadikin Hospital, enrolled 40 subjects with intracranial meningioma underwent surgical excision. The objective of this study is to see the effect of tranexamic acid (TXA) in reducing bleeding and transfusion requirements

Subjects and Method: Subjects divided into two groups, group A received tranexamic acid 20 mg/kg body weight in 100 mL normal saline, and group B received 100 mL normal saline before incision. Intraoperative hemodynamics, amount of fluid, transfusions, and blood loss were recorded hourly. Hemoglobin, hematocrit, and coagulation factors measured in postoperative, and subjects were followed up for the first 24 hours to record transfusion requirements and laboratorium work up. We analyzed the data using t-test and Mann-Whitney test.
Results: Intraoperative blood loss (1008,51±327,192 vs 1347±539,120 ml; p=0,021), intraoperative packed red cell (PRC) transfusion requirement (89,30±152,970 ml vs 306,85±224,631 ml, p=0,003), PRC transfusion requirement in first 24 hours postoperative (88,50±153,014 ml vs 212,00±212,505 ml, p=0,028) in group A significantly less than group B
Conclusions: Administration of intravenous tranexamic acid 20 mg/kg before incision can reduce intraoperative blood loss and transfusion requirement in patients underwent surgical excision of meningioma