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.

Background Pain is a common symptom among individuals with gastrointestinal (GI) malignancies; yet, opioid use patterns and frequency remain understudied. Our study aims to characterize the frequency and patterns of opioid use among individuals with a history of GI malignancy diagnoses. Methods This study is a retrospective analysis of cross-sectional data from the 2019 and 2020 National Health Interview Survey (NHIS). A total of 594 adults with a previous diagnosis of GI cancer, namely, esophageal, stomach, pancreatic, liver, gallbladder, or colorectal cancers, were identified. Of these, 536 reported prescription medication use in the past 12 months and constituted the analytic population for opioid-use outcomes. Multivariate regression analysis with adjustment for sociodemographic and clinical covariates was used to identify factors associated with opioid use within the GI cancer cohort. As a secondary exploratory analysis using a different reference population (absence of each cancer type in the full cancer-history sample), we compared opioid use across all reported malignancy subtypes. Results Opioid use was reported by 143 out of the 536 respondents with a history of GI malignancy, who used prescription medications (26.67%), were younger (66.44 vs. 73.31 years, p<0.001), and were more likely to be smokers (87 (60.8%) vs. 193 (49.1%), p=0.02) compared with non-users. Among chronic users, 37 (46.6%) individuals reported daily use of opioids. Those with liver cancer and esophageal cancer had the highest rates of opioid use in the past 12 months (42.8% and 39.9%) and the lowest with colorectal malignancy (20.7%). Younger age and smoking history were independently associated with opioid use (adjusted odds ratio (aOR) 0.95 and aOR 1.61, respectively). Liver cancer (aOR 0.42) and colorectal cancer (aOR 0.52) were associated with lower odds of opioid use relative to other GI malignancy subtypes. In a separate exploratory model comparing opioid use across all reported cancer diagnoses, liver and esophageal cancers showed the strongest associations with opioid use (aOR 3.10 and aOR 2.85, respectively). Conclusion Opioid use is prevalent among GI cancer survivors and varies by malignancy subtype, with individuals diagnosed with esophageal and liver cancer showing the strongest association with opioid use, supporting consideration of cancer subtype-specific pain management strategies.