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What you need to knowWorldwide at least 200 per 100 000 people are killed or admitted to hospital each year after traumatic brain injury.1 This results in more than 10 million deaths or hospital admissions.2 In the UK, around one million people attend emergency departments every year with a traumatic brain injury.3Intracranial bleeding is common after traumatic brain injury, and the larger the bleed the greater the risk of death and disability.4 5 Bleeding continues after hospital admission in 84% of patients with moderate or severe injuries,6 7 and can continue for up to 24 hours.8 About one third of patients have laboratory evidence of abnormal coagulation.9 High levels of fibrin degradation products are seen within the first three hours.10 Such patients have a higher risk of intracranial haemorrhage and mortality.Tranexamic acid reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots (fig 1⇓).Fig 1  A Normal fibrinolysis. B: Fibrinolysis inhibited by tranexamic acid. Plasmin binds to fibrin via lysine binding sites and then splits fibrin into fibrin degradation products. Tranexamic acid is a molecular analogue of lysine that inhibits fibrinolysis by reducing the binding of plasmin to fibrinTranexamic acid is used routinely in some cases of trauma and in surgery. For example, it reduces the need for blood transfusion in surgical patients.11 12 In trauma patients with extracranial haemorrhage:13

Does tranexamic acid improve outcomes in traumatic brain injury?