Abstract: Background and Objective: Tranexamic acid prevents bleeding by fibrinolysis. In patients with acute traumatic injuries, tranexamic acid is widely used in hospitals but it is not clear whether early tranexamic acid is beneficial for patients with acute traumatic brain injuries. The objectives of the study were to evaluate the effectiveness and safety of early tranexamic acid in patients with acute traumatic brain injuries regarding morbidity and mortality. Materials and Methods: Patients with acute traumatic brain injuries have received tranexamic acid within 3 hrs of injuries (TX cohort, n = 149) or have not received it (NS cohort, n = 115) because pregnant women, had unknown onset time for trauma, need for reconstructive surgeries, had cerebral oedema and/or subarachnoid haemorrhage. Results: The number of deaths within 24 hrs of injuries was fewer among patients who received tranexamic acid than those who did not receive tranexamic acid (7 vs. 10%). Reduction in the risk of death in patients with mild to moderate head injuries (Glasgow Coma Scale score: 9-12) on the administration of tranexamic acid (p = 0.042). Administration of tranexamic acid has reduced the risk of death in patients with less severely injured patients (two reacted pupils) (p = 0.008). Tranexamic acid had no adverse effects. Conclusion: Tranexamic acid treatment initiated within 3 hrs of injuries is effective in acute traumatic brain injuries especially in cases of mild to moderate head injuries.