Abstract Background Early administration of tranexamic acid (TXA) has been shown to reduce mortality in trauma patients with suspected bleeding. In the context of modern haemostatic resuscitation there is however concern that TXA may lead to thromboembolic (TE) complications. The aim of this study was to evaluate if the appropriate patients were selected for TXA treatment by pre- and inhospital physicians. We also aimed to discern whether TXA administration was associated with TE complications and survival. Methods Data were collected from trauma patients admitted directly at Oslo University Hospital Ullevål during a 2-year period. Inclusion criteria were trauma patients ≥18 years old, and who received TXA or more than two units of packed red blood cells (PRBCs) within the first 12 hours. Patient charts were reviewed with respect to demographics, number and types of blood products given and TXA administration. Data on TE episodes was prospectively recorded. We calculated the frequencies of appropriately administered TXA based on the definition that TXA was indicated in patients who received at least four units of PRBCs. Logistic regression analyses were performed to identify factors associated with incidence of TE complications and survival to discharge. Results A total of 136 patients were included in the analyses. Median age was 51 years (IQR 31). 108 cases (80%) were blunt injuries and median ISS was 22 (IQR 20). TE complications were observed in 15 (11%) patients and 112 patients (82%) survived until discharge. A total of 107 patients received TXA. According to our definition, TXA was indicated in 48 patients. 36 of these (75%) did not receive TXA prehospitally whereas 11 (19%) did not receive TXA during inhospital treatment. Moreover, TXA was administered unnecessarily in 34 of 46 patients (74%) prehospitally and 28 of 74 (38%) in hospital. In a logistic regression model adjusting for injury severity, age, and transfusion requirements, TXA was not found to be an independent predictor of TE complications. Administration of TXA was however associated with a survival benefit with an odds ratio of 3,78 (95% CI: 1.27-11.50, p=0,02). Discussion The current study indicates that a relatively large proportion of patients with significant bleeding do not receive TXA appropriately. On the other hand, an even larger proportion of patients are given TXA although not indicated according to our definition. In this limited patient cohort TXA administration was associated with a significant increase in survival without detectable increased risk of TE complications.