The authors reviewed published and unpublished randomized controlled trials on the use of hemostatic drugs (antifibrinolytics and rFVIIa) for traumatic brain injury (TBI). Only two trials (one was a subgroup post-hoc analysis) involving the use of rFVIIa were included in the review. The authors conclude that there is no reliable evidence from randomized controlled trials to support the effectiveness of hemostatic drugs in reducing mortality or disability in patients with TBI. In the absence of conclusive data on the efficacy and safety of hemostatic drugs in the context of TBI, clinicians should avoid their use for this indication.