René Post and colleagues1 report that, among a cohort of 955 patients with spontaneous CT-proven subarachnoid haemorrhage, ultra-early, short-term tranexamic acid treatment did not improve clinical outcome at 6 months (treatment centre adjusted odds ratio 0·86, 95% CI 0·66–1·12), as measured by the modified Rankin scale. They also found no significant difference in rebleeding before aneurysm treatment between patients receiving tranexamic acid and the control (0·71, 0·48–1·04). A 2018 meta-analysis by Huang and colleagues2 reported that non-vitamin K antagonist oral anticoagulants confer a significantly higher (and dose-dependent) risk of an intracranial haemorrhage compared with aspirin; therefore, more granular information regarding the use of anticoagulant medication in the ULTRA trial1 cohort might highlight potentially important differences between the tranexamic acid and control groups.