The Effectiveness and Safety of Tranexamic Acid in Treating Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

Abstract

Background/Objectives: Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that inhibits plasminogen activation, thereby reducing bleeding. The aim of this systematic review was to investigate its role in aneurysmal subarachnoid hemorrhage (SAH)-a condition indicated by bleeding between two layers of brain tissue-to stop rebleeding and improve patient outcomes. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials from 1981 to 2024, focusing on the efficacy and safety of TXA in treating aneurysmal SAH (PROSPERO registration: CRD42024504834). Our comprehensive search of the PubMed and Cochrane Library databases identified studies assessing TXA at dosages of 3 to 6 g per day and examining outcomes such as rebleeding incidence, mortality, thromboembolic events, and other adverse effects. Results: From six included studies involving 2990 patients, the meta-analysis showed TXA largely lowered rebleeding risk (OR 0.54 95% CI 0.43-0.68; p < 0.00001), yet mortality rates were not largely different between the TXA group (385 out of 1201), and the control group (344 out of 1193) (OR 1.18 95% CI 0.98-1.40; p = 0.07). Likewise, there were no large differences in the occurrence of cerebral ischemia and blood clot-related events between the groups. Conclusions: TXA effectively reduces the risk of rebleeding in SAH patients, but does not significantly alter mortality or the incidence of thromboembolic complications. These findings back the careful use of TXA and demonstrate the need for further research to better its clinical use and assess long-term impacts.