Spontaneous intracerebral hemorrhage (ICH) is a common cause of mortality and disability. Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to reduce mortality in patients with traumatic injury and postpartum hemorrhage. The Tranexamic acid for hyperacute primary IntraCerebral Hemorrhage trial (TICH) is an international, double blinded, placebo controlled randomized control trial to test whether TXA administration within 8 hour of ICH will reduce mortality and improve outcome in ICH. Out of 2325 enrolled patients, primary outcome data was available in 2307 patients and there was no difference in terms of mortality or functional outcome based on modified Rankin scale at 90 day between ICH patients who received TXA versus placebo. Among the secondary outcome, there was slight reduction in early mortality, occurrences of serious adverse events (within 7 days), and hematoma expansion among patients who received TXA. Larger randomized trial will be needed to identify whether subgroup(s) of patients will benefit from TXA.