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.

Psoriasis and rheumatoid arthritis (RA) are common chronic diseases with distinctive histological and molecular features. However, there are similarities in their immunological pathogenesis, leading to the use of some similar systemic biological treatment. In 5% of patients using biological therapy such as the anti-tumor necrosis factor alpha (anti-TNF-α), a paradoxical reaction (i.e., the exacerbation or development of one disease while treating the other) may develop. We report a case of a 27-year-old female diagnosed with seropositive RA who developed paradoxical psoriasis (PP) after the use of Adalimumab, an anti-TNF-α, and paradoxical eczema due to the use of Ixekizumab, an anti-interleukin-17A, for the treatment of PP. This case demonstrates the occurrence of two different types of paradoxical skin reactions in a single patient. This case also highlights the importance of the selection and cessation of biological treatment in similar cases, as well as the factors that might predict the development of paradoxical reactions to promote the safe usage of biological therapy.