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Review
. 2025 Jan 10;20(2):219-228.
doi: 10.1055/s-0044-1801771. eCollection 2025 Jun.

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

Mohammad Amin Habibi  1 , Seyed Ahmad Naseri Alavi  2 , Amir Reza Boskabadi  3 , Farid Qoorchi Moheb Seraj  4 , Mohammad Sina Mirjnani  5 , Mohsen Benam  6 , Firooz Salehpour  7 , Andrew J Koets  8
Affiliations
Review

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

Mohammad Amin Habibi et al. Asian J Neurosurg. .

Abstract

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.

Keywords: chronic subdural hematoma; craniotomy; subdural hematoma; tranexamic acid.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of the study selection process.
Fig. 2
Fig. 2
The recurrence rate between adjuvant tranexamic acid (TXA) to surgery (TXA group) and surgical management only (control group).
Fig. 3
Fig. 3
The reoperation rate between adjuvant tranexamic acid (TXA) to surgery (TXA group) and surgical management only (control group).
Fig. 4
Fig. 4
The hematoma reduction between adjuvant tranexamic acid (TXA) to surgery (TXA group) and surgical management only (control group).
Fig. 5
Fig. 5
The comparison of mortality rate between adjuvant tranexamic acid (TXA) to surgery (TXA group) and surgical management only (control group).
Fig. 6
Fig. 6
The forest plot of serious adverse events between adjuvant tranexamic acid (TXA) to surgery (TXA group) and surgical management only (control group). Complications were not significantly different between the two groups ( p -Value: 0.96).
Fig. 7
Fig. 7
The forest plot of thromboembolic complication rate between adjuvant tranexamic acid (TXA) to surgery (TXA group) and surgical management only (control group).
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References

    1. Mehta V, Harward S C, Sankey E W, Nayar G, Codd P J. Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. J Clin Neurosci. 2018;50:7–15. - PubMed
    1. Almenawer S A, Farrokhyar F, Hong C et al.Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg. 2014;259(03):449–457. - PubMed
    1. Liu W, Bakker N A, Groen R JJJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014;121(03):665–673. - PubMed
    1. Omura Y, Ishiguro T. Middle meningeal artery embolization for chronic subdural hematoma: a systematic review. Front Neurol. 2023;14:1.259647E6. - PMC - PubMed
    1. Sattari S A, Yang W, Shahbandi A et al.Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: a systematic review and meta-analysis. Neurosurgery. 2023;92(06):1142–1154. - PubMed

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