2075 The Effect of Tranexamic Acid After Burr Hole Craniotomy on Recurrence of Chronic Subdural Hematoma: A Meta-Analysis

INTRODUCTION: Chronic subdural hematoma (CSDH) represents a significant neurosurgical challenge, particularly prevalent among the elderly. It is commonly managed through surgical evacuation, yet recurrence rates remain at approximately 13%. Given these statistics, various adjuvant therapies have been explored, such as tranexamic acid (TXA) in order to improve outcomes. Despite these efforts, there is still no clear consensus regarding the efficacy and safety of TXA in this setting. This study aims to assess the utility of TXA as an adjunctive treatment to not only decrease the recurrence of CSDH but also to manage associated complications and ultimately refine the overall clinical approach to treating these patients. METHODS: A comprehensive database search was performed up to January 23, 2024, to identify studies that document clinical outcomes of patients with CSDH treated with TXA. The primary outcomes assessed were recurrence of hematoma, overall survival, and the rate of complications. RESULTS: Out of the initial 277 articles retrieved, 6 met the inclusion criteria, comprising 4 randomized controlled trials and 2 observational cohort studies. The collective sample consisted of 14,514 patients. Analysis revealed that compared to the control group not receiving TXA, the TXA-treated group exhibited a significant reduction in recurrence rates (RR = 0.33, 95% CI = 0.27-0.39). Additionally, there was a lower incidence of thrombosis (RR = 0.54, 95% CI = 0.43-0.68), although the difference in stroke occurrence was not statistically significant (RR = 1.07, 95% CI = 0.66-1.73). CONCLUSIONS: Our study suggests that administering TXA following surgical management could reduce the recurrence of CSDH in patients who have undergone surgery. Additionally, TXA may help mitigate the risks associated with thrombosis and stroke. However, it is crucial to acknowledge the limitations of this study. Further research is needed to validate these findings and fully understand the impact of TXA in the post-surgical treatment of CSDH.