Hemorrhage is the most important factor for acute-phase mortality in trauma patients, and our understanding of coagulopathy in patients with severe trauma has markedly improved. Although the pathophysiology of trauma-associated coagulation impairment has not been clarified, trauma itself and/or the traumatic shock-induced fibrinolytic condition is referred to as acute traumatic coagulopathy, and multifactorial trauma-associated coagulation impairment, including acute traumatic coagulopathy and resuscitation-associated coagulopathy, is recognized as trauma-induced coagulopathy. Prevention and management of traumatic coagulopathy based on the scientific background of trauma-induced coagulopathy are core strategic components. Tranexamic acid, a widely used antifibrinolytic agent, is one core component in the management of acute traumatic coagulopathy. Recognition of recent evidence regarding the effectiveness and usefulness of tranexamic acid in patients with trauma, and a clear understanding that “traumatic-associated coagulopathy and antifibriolytic therapy is a battle against time” are essential in trauma care.