A randomized, double-blind, placebo-controlled, non-inferiority trial in 3 Korean hospitals aims to compare ROTEM-guided TXA administration with preemptive TXA in elective cardiovascular surgery, focusing on postoperative blood loss, transfusions, and complications. The trial, registered in 2023, involves 764 patients and follows institutional protocols for perioperative management, with data managed by a CRO.