Objective To examine the efficacy of oral tranexamic acid in the conservative treatment of mixed-density chronic subdural hematoma (CSDH).Methods A total of 22 patients with CT-confirmed mixed-density CSDH in our hospital from January 2013 to June 2016 were included in this study. All patients received an oral dose of 250 mg tranexamic acid three times a day for 1 to 3 months, and were followed up for 4 to 6 months. The change in hematoma volume and recovery of neurological function after treatment were examined, and the changes in head CT were also observed.Results Of the 22 patients, 16 (72.7%) showed response, 4 (18.2%) showed no response, and 2 (9.1%) were lost to follow-up. Clinical symptoms, including headache and limb weakness, were improved in 16 patients after 1 month of treatment with oral tranexamic acid; after 3 months, these symptoms almost disappeared in these patients, with significant hematoma absorption on head CT. Clinical symptoms were exacerbated in 3 patients after 3 to 4 weeks of treatment, and the patients were admitted to the hospital for surgery; oral administration of tranexamic acid was continued in these patients after surgery, and no relapse was observed during the 6 months of follow-up. One patient had significantly improved clinical symptoms after 1 month of treatment, with mostly low-density hematoma and reduced hematoma absorption; however, treatment was discontinued in this patient later on due to gastrointestinal discomfort. Two patients were lost to follow-up at weeks 8 and 12 of treatment, respectively.Conclusions Oral tranexamic acid is safe and efficacious in the conservative treatment of mixed-density CSDH, and can reduce postoperative relapse of mixed-density CSDH following trepanation and drainage.