[Should all patients with traumatic brain injury receive tranexamic acid?]

Traumatic brain injury (TBI) is a leading cause of death and disability. Progressive intracranial bleeding is common in TBI and worsens outcome. The multicentre, randomized placebo-controlled CRASH-3 study enrolling 12,737 patients showed that early, <3h, administration of tranexamic acid (TXA) decreased mortality in mild-moderate TBI patients. In accordance with large previous trials, thromboembolic complications were not increased. In view of the favourable safety profile of TXA and the devastating effects from intracranial bleeds, the authors argue that TXA be administered within 3h post-injury to moderate-severe TBI patients, and in mild TBI to those with intracranial haemorrhage on acute CT.