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 and progress of intracranial hemorrhage (ICH). The hemostatic drug tranexamic acid (TXA) with anti-fibrinolytic activity is usually used in patients with trauma to reduce hematoma size. 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 the volume of intracranial bleeding in patients with TBI admitted to Critical Care Unit at Menoufia University Hospital. Patients and methods: A prospective randomized placebo-controlled double blinded study in the Critical Care Unit, Menoufia University hospitals, through one year from January 2020 to January 2021. The study was carried out on 40 patients with TBI with Glasgow Coma Scale (GCS) of 4 to 12. They had a computerized tomography (CT) brain scan within 8 hours of injury and in whom there was no indication for immediate surgical intervention. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 hours) or matching placebo. Results: There was statistically significant reduction in the volume of ICH after 48 hours (p = 0.021) in TXA group than in placebo group. While in placebo group, there was high statistically significant increase in volume of ICH after 48 hours compared to on admission. Moreover, TXA reduced the need of blood transfusion, surgical intervention and the incidence of complications with no evidence of increased risk of thromboembolic events. Conclusion: TXA may reduce the volume of ICH in patients with TBI with no evidence of increased risk of thromboembolic events.