Background There are various treatment modalities for chronic subdural hematoma (CSDH) and there is extensive debate surrounding pharmaceutical interventions. There is no consensus regarding the relative efficacy and safety of multiple treatment modalities. This study aims to investigate this issue and offer potential clinical recommendations. Methods We searched PubMed, Web of Science, Embase and the Cochrane Library from January 2000 to May 2023 to identify randomized and nonrandomized controlled studies reporting one or more outcomes associated with the pharmacologic management of CSDH. The primary outcomes of interest included recurrence, favorable prognosis and adverse events, while the secondary outcomes included a reduction in hematoma volume and mortality. Pooled estimates, credible intervals and odds ratios were calculated for all outcomes using a fixed effects model. Confidence in network meta-analysis judgments were employed to stratify the evidential quality. This study was registered with PROSPERO: CRD42023406599. Results The search strategy yielded 656 references; ultimately, 36 studies involving 8082 patients fulfilled our predefined inclusion criteria. The findings suggested that statins + glucocorticoids (GCs) ranked highest for preventing recurrence, improving prognosis and facilitating hematoma absorption. Tranexamic acid ranked second highest for preventing recurrence. Statins were found to be the preferred drug intervention for decreasing mortality and preventing adverse events. Antithrombotic agents ranked lowest in terms of decreasing mortality and improving prognosis. Conclusions Our findings indicate that statins + GCs may be the most effective treatment modality for preventing recurrence, improving patient prognosis and facilitating hematoma absorption. In terms of reducing mortality and preventing adverse events, statins may be superior to other pharmacological interventions. Routine use of GCs is not suggested for patients with CSDH. Further prospective research is needed to directly compare the efficacy and superiority of various pharmaceutical interventions targeting CSDH to reinforce and validate our findings.

中文翻译：

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慢性硬膜下血肿的药理学景观：随机和非随机对照研究的系统回顾和网络荟萃分析。


背景 慢性硬膜下血肿（CSDH）有多种治疗方式，并且围绕药物干预存在广泛的争论。关于多种治疗方式的相对疗效和安全性尚未达成共识。本研究旨在调查这个问题并提供潜在的临床建议。方法 我们检索了 2000 年 1 月至 2023 年 5 月期间的 PubMed、Web of Science、Embase 和 Cochrane 图书馆，以确定报告与 CSDH 药物管理相关的一项或多项结果的随机和非随机对照研究。感兴趣的主要结局包括复发、良好预后和不良事件，而次要结局包括血肿体积和死亡率的减少。使用固定效应模型计算所有结果的汇总估计值、可信区间和比值比。利用网络荟萃分析判断的置信度对证据质量进行分层。本研究已在 PROSPERO 注册：CRD42023406599。结果 检索策略产生 656 篇参考文献；最终，涉及 8082 名患者的 36 项研究满足了我们预先定义的纳入标准。研究结果表明，他汀类药物+糖皮质激素（GC）在预防复发、改善预后和促进血肿吸收方面排名最高。氨甲环酸在预防复发方面排名第二。他汀类药物被发现是降低死亡率和预防不良事件的首选药物干预措施。抗血栓药物在降低死亡率和改善预后方面排名最低。 结论 我们的研究结果表明他汀类药物+GCs可能是预防复发、改善患者预后和促进血肿吸收的最有效的治疗方式。在降低死亡率和预防不良事件方面，他汀类药物可能优于其他药物干预措施。不建议 CSDH 患者常规使用 GC。需要进一步的前瞻性研究来直接比较针对 CSDH 的各种药物干预措施的功效和优越性，以加强和验证我们的研究结果。