Oh, what a surprise, another day in the neurosurgical neighborhood where we find ourselves grappling with the ever-so-prevalent chronic subdural hematoma (CSDH), especially among our cherished elderly population. In a groundbreaking effort to leave no stone unturned, a group of intrepid researchers embarked on a quest to assess the efficacy and safety of the latest knight in shining armor: tranexamic acid (TXA). Because, you know, despite the myriad of treatments available, we just can’t seem to keep those pesky CSDHs from making unwelcome comebacks.

Adhering to the 2020 PRISMA guidelines like it’s the holy grail of research protocols, our heroes scoured three primary databases (Scopus, PubMed, and Web of Science) for articles. Their journey spanned from the dawn of time until October 20, 2023, in search of the elusive answer. The main villain in this saga? Recurrence of CSDH. But let’s not forget about the sidekicks: complications and SDH volume post-TXA treatment. Armed with the random-effects model, they calculated mean differences and odds ratios, because who doesn’t love a good statistical showdown?

After what I can only imagine was an epic battle through the literature, a total of five studies, involving 643 patients in the TXA camp and 736 in the non-TXA camp, were deemed worthy. And lo and behold, TXA emerged victorious, significantly lowering CSDH recurrence (OR 0.35, p < 0.01) without rallying the troops of complications (OR 1.84, p = 0.42). Furthermore, TXA users flaunted a significantly lower CSDH volume at the 3-month victory parade (mean difference -4.56, p = 0.03).

So, the moral of the story? TXA might just be the hero we’ve been waiting for in the fight against CSDH recurrence, not to mention it doesn’t seem to invite more complications to the party. But, in a twist that no one saw coming (except everyone), the researchers caution us to not throw a ticker-tape parade just yet. With only a handful of studies making the cut and a delightful mix of methodological diversity, it’s like saying, “This looks promising, but let’s not get ahead of ourselves.” Because, of course, what we truly need are more large-scale randomized controlled trials to really seal the deal. Because in the world of medical research, it’s never really over, is it?