ObjectivesOur objective was to compare the effectiveness of TXA in improving recurrence in patients with chronic subdural hematoma (CSDH).MethodsEligible randomized controlled trials (RCTs), prospective trials and retrospective cohort studies were searched in PubMed, Cochrane Library, Embase, and CNKI from database inception to December 2023. After the available studies following inclusion and exclusion criteria were screened, the main outcome measures were strictly extracted. Reman v5.4. was used to assess the overall recurrence rate. A random-effects model was used to assess pooled ORs, with the Mantel–Haenszel estimation method applied. Cochran Q (Chi-square) test and I2 statistics were used to assess inter-study heterogeneity. Funnel plots were used to evaluate publication bias.ResultsFrom the 141 articles found during initial citation screening, 9 literatures were ultimately included in our study. Our NMA results illustrated that patients with newly diagnosed Chronic subdural hematoma revealed a significantly improved recurrence rate when patients were treated with Tranexamic acid (OR: 0.33; 95% CI 0.26–0.41; p < 0.00001) compared with standard neurosurgical treatment. There was no significant difference in the incidence rates of thrombosis (OR: 0.84; 95% CI 0.63–1.12; p = 0.23) and mortality (OR: 1.0; 95% CI 0.57–11.76; p = 0.99), Occurrence of myocardial infarction was significantly less frequent in TXA users than in nonusers (OR: 0.18; 95% CI 0.04–0.82; p = 0.03).ConclusionTXA can effectively improve the recurrence rate of CDSH. It provides a high level of evidence-based medicine for clinical treatment. In addition, multicenter randomized controlled trials, with dose adjustments, are still needed to determine whether TXA intervention improves neurological function or prognosis.

中文翻译：

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氨甲环酸对慢性硬膜下血肿复发的疗效：荟萃分析和系统评价

目的我们的目的是比较 TXA 在改善慢性硬膜下血肿 (CSDH) 患者复发方面的有效性。方法在 PubMed、Cochrane Library、Embase 和 CNKI 数据库中检索符合条件的随机对照试验 (RCT)、前瞻性试验和回顾性队列研究起始至2023年12月。按照纳入和排除标准对现有研究进行筛选后，严格提取主要结局指标。再制造 v5.4。用于评估总体复发率。使用随机效应模型来评估汇总 OR，并应用 Mantel-Haenszel 估计方法。 Cochran Q（卡方）检验和 I2 统计用于评估研究间的异质性。使用漏斗图来评估发表偏倚。结果在初步引文筛选过程中发现的 141 篇文章中，最终纳入了 9 篇文献。我们的 NMA 结果表明，新诊断的慢性硬膜下血肿患者接受氨甲环酸治疗后，复发率显着改善（OR：0.33；95% CI 0.26-0.41；p< 0.00001）与标准神经外科治疗相比。血栓发生率无显着差异（OR：0.84；95% CI 0.63-1.12；p= 0.23）和死亡率（OR：1.0；95% CI 0.57–11.76；p= 0.99），TXA使用者心肌梗死的发生率明显低于非使用者（OR：0.18；95% CI 0.04-0.82；p= 0.03)。结论TXA可有效提高CDSH的复发率。它为临床治疗提供了高水平的循证医学。此外，仍需要进行剂量调整的多中心随机对照试验来确定TXA干预是否可以改善神经功能或预后。