Can tranexamic acid improve outcomes in traumatic brain injury (TBI)? The CRASH-3 trial evaluated the effects of tranexamic acid on patients with acute TBI. A total of 12,737 patients were randomized to receive either tranexamic acid or placebo within 3 h of injury. Improved survival with tranexamic acid was confined to patients who suffered mild and moderate head injury; no beneficial impact was observed among patients with severe injury. Disability among survivors was also similar. The treatment did not lead to a higher incidence of vascular occlusive events. The trial contributed to a more nuanced understanding of the role of tranexamic acid in the management of TBI, particularly focusing on early administration for hemorrhage control.