The Use of Tranexamic Acid in the Treatment of Symptomatic Subdural Hematoma

Inclusion Criteria: * Patients aged 45 and older weighing between 45-150 kg diagnosed with symptomatic SDH will be included. SDH is defined as unilateral or bilateral crescentic collection of blood (hyper, iso, or hypodense, or mixed density) of greater than or equals to 8 mm in thickness along the cerebral convexity on CT of the head. Symptomatic SDH patients eligible for inclusion are those with SDH with one or more of the following symptoms attributable to the SDH: headache, gait disturbance, confusion or cognitive decline, limb weakness or numbness/paresthesia, speech or visual disturbance, drowsiness or impaired consciousness, seizures, impaired cognition, or memory loss at the time of assessment. Exclusion Criteria: \- Patients will be excluded for any of the following conditions: 1. Asymptomatic for longer than 72 hours 2. SDH less than 8 mm in maximal thickness 3. Have an acutely deteriorating neurological status (e.g., brain herniation with pupillary dilation, aneurysm rupture, etc.) that is likely to be fatal within 6 hours or less due to a predominantly acute SDH 4. Presence of brain contusion larger than 5 cubic centimeters or subarachnoid hemorrhage (SAH) thicker than 10 mm with Glasgow Coma Scale (GCS)\< 13 5. Patients with primarily interhemispheric or tentorial SDH 6. Hypersensitivity to TXA or any of the placebo ingredients 7. Pregnancy 8. Irregular menstrual bleeding with unidentified cause 9. Known acquired colour vision disturbances 10. Hematuria caused by renal parenchymal disease 11. Acute and chronic renal insufficiency indicated by estimated Glomerular Filtration Rate (eGFR) ≤ 30 mL/min 12. Concomitant intake of birth control pill and/or hormonal replacement therapy, and anti-inhibitor coagulant concentrates (factor VIII inhibitor bypass activity (FEIBA), factor VII, activated factor IX) 13. Consumption coagulopathy/disseminated intravascular coagulation (DIC) in the last 7 days 14. Not competent to take study medication properly and regularly or not having access to caregiver that is able to comply with study medication administration 15. Mechanical heart valve 16. Liver cirrhosis 17. Recent venous and/or arterial thromboembolism within 6 months of study enrolment 18. SDH caused by intracranial hypotension 19. Known thrombophilia (e.g., antiphospholipid syndrome) 20. Any active malignancy: metastatic cancer systemically or to the brain or a primary malignant brain tumour treated within the last 6 months 21. Previous enrolment in this trial for a prior episode 22. Time interval \>3 days from the time of clinical assessment to eligibility assessment 23. Patients weighing \<45 kg or \>150 kg 24. Patients received any amount of TXA upon admittance to hospital prior to enrolment