AimThe efficacy of antifibrinolytics in subarachnoid hemorrhage remains unclear due to conflicting evidence from studies.Materials & methodsOnline databases were queried to include randomized controlled trials and propensity matched observational studies. We used Review Manager for the statistical analysis, presenting results as odds ratios with 95% CI.ResultsThe 12 shortlisted studies included 3359 patients, of which 1550 (46%) were in the intervention (tranexamic acid) group and 1809 (54%) in the control group. Antifibrinolytic therapy significantly reduced the risk of rebleeding (OR: 0.55; 95% CI: 0.40–0.75; p = 0.0002) with no significant decrease in poor clinical outcome (OR: 1.02; 95% CI: 0.86–1.20; p = 0.85) and all-cause mortality (OR: 0.92; CI: 0.72–1.17; p = 0.50).ConclusionIn patients with subarachnoid hemorrhage, antifibrinolytics reduce the risk of rebleeding without significantly affecting mortality or clinical outcomes.