Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 20 679 685 Sohrab Salimi Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sara Salarian Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Noor Mohammad Arefian Department of Anesthesiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamidreza Khayat Kashani Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Niloofar Abdous Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Dariush Abtahi Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 03 09 2025 03 18 Background: The optimal dosing regimen of tranexamic acid (TXA) for minimizing blood loss during supratentorial brain tumor resection remains undefined. This study compared two dosing protocols to evaluate efficacy and safety. Methods: In this double-blind, randomized trial (September 2020–September 2021), 60 patients aged 18–60 years undergoing supratentorial tumor surgery were allocated to receive either TXA1 (20 mg/kg bolus + 1 mg/kg/h infusion) or TXA3 (20 mg/kg bolus + 3 mg/kg/h infusion). Primary outcomes included intraoperative blood loss; secondary outcomes encompassed transfusion needs, surgical duration, hospitalization length, and thromboembolic complications. Results: The TXA3 group demonstrated an 18% reduction in mean intraoperative blood loss compared to TXA1 (402.93 mL vs. 470.61 mL; mean difference −67.68 mL, 95% CI −139.4 to 3.9; p = 0.053). Transfusion requirements were lower in the TXA3 cohort (0.43 ± 0.9 vs. 0.64 ± 1.2 units; p = 0.34), though not statistically significant. Surgical duration was prolonged in the TXA3 group (p = 0.047), but hospitalization was shorter (p = 0.049). Thromboembolic event rates were comparable between groups (p > 0.05). Conclusion: Higher intraoperative TXA infusion rates were associated with reduced blood loss and shorter hospital stays without elevating thromboembolic risk. These findings support TXA’s utility in improving perioperative outcomes and resource efficiency for supratentorial tumor resection. https://aacc.tums.ac.ir/index.php/aacc/article/view/1230