Aim: Chronic subdural hematoma (cSDH) is a neurosurgical pathology of significant prevalence, with an expected increase in incidence in the coming decades due to population aging and greater use of anticoagulant medications. Although surgical management is still considered the cornerstone of cSDH treatment, recurrence and operative morbidity have prompted research into pharmacological options. Tranexamic acid (TXA) is a well-established antifibrinolytic clinically used in severe trauma and postpartum hemorrhage control. This study aims to systematically evaluate the existing literature regarding adjuvant or primary treatment of cSDH with TXA. Material and Methods: This systematic review followed the parameters set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search in the available literature was conducted up to February 2024 in five databases using the keywords \"chronic subdural hematoma\" and \"tranexamic acid.\" Randomized clinical trials, prospective or retrospective cohorts, systematic reviews, and case series (> five patients) relevant to the analysis were included. Results: In total, 10 studies were included, encompassing a total of 912 patients diagnosed with cSDH who underwent treatment with TXA. Seven studies evaluated the use of TXA as an adjunctive to surgical treatment, and three articles investigated the effect of TXA as primary therapy. Conclusion: TXA can be considered a safe and effective option in adjunct to surgical management. Further studies are needed to establish its role as primary treatment. Keywords: Tranexamic acid, Chronic subdural hematoma, Systematic review.