Is It Safe to Use Tranexamic Acid for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

Trans-4-(aminomethyl)-cyclohexane-1-carboxylic acid, also known as tranexamic acid (TXA), has occasionally been used to prevent postoperative recurrence of chronic subdural hematoma (CSDH) after burr hole craniotomy (BC). However, there is a lack of data about the safety and efficacy of TXA administration after BC. This systematic review and meta-analysis adhered to the Cochrane Handbook Standards Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searching databases up to January 2024 for randomized controlled trials and cohort studies evaluating TXA. The primary outcome was CSDH recurrence and reoperation. The secondary outcome was thrombosis risk and mortality rate. Ten studies were included, comprising 14,836 patients with CSDH who underwent surgical treatment. Five studies were randomized controlled trials, while the other two case series and three cohort studies. The overall pooled hematoma recurrence rate in the group of patients who used TXA as an adjuvant treatment to the surgical intervention (TXA group), compared with patients who only used surgery to treat CSDH (control group), was 0.05 (95% confidence interval [0.03-0.08], p  < 0.01), indicating a significant reduction in recurrence with TXA treatment. TXA, as an adjuvant treatment to the surgical intervention, reduces the risk of postoperative hematoma recurrence, reoperation, thromboembolic complication, and mortality related to CSDH after BC in elderly patients.