Background: Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage secondary to TBI is associated with a high risk of coagulopathy, which leads to increasing risk of hemorrhage growth, poor functional outcome and higher mortality rate. The hemostatic drug tranexamic acid with anti-fibrinolytic activity is usually used in patients with trauma. Because of its potential role in reducing hematoma size, which prevents secondary TBI, it has been considered a possible therapy to improve the clinical outcome in patients with TBI. Objective: To evaluate the effect of tranexamic acid on volume changes of intracranial bleeding in patients with TBI admitted to Emergency Department at Mansoura University Emergency Hospital. Patients and methods: This is prospective interventional study randomized controlled trials carried out on 100 patients with TBI and admitted at Mansoura University Emergency Hospital; a level 1 trauma center with about 250,000 visits and 25000 trauma cases admission per year, through one year from October 2019 to October 2020. Results: The clinical outcome was better in tranexamic group as it was associated significantly with improved motor GCS and less need for neurosurgical intervention. The secondary outcome was much better in tranexamic acid group which was associated with less hospital LOS, better GOS and less mortality rate. Conclusion: Early administration of tranexamic acid (within 3 hours of injury onset) can limit the extent of bleeding before the hemorrhagic volume may become dangerous, while late administration can be useless.