Managing acute traumatic coagulopathy involves several interventions, including tranexamic acid, plasma transfusion, factor administration, or coagulation therapy guided by viscoelastic methods. However, the range of evidence to support these strategies is variable or needs more consensus, and translation to clinical practice is challenging. To address these challenges, we propose a narrative review of randomized controlled trials published during the last two decades. This review will clarify how interventions have been evaluated, the specific populations involved, and the potential benefits and risks identified. By synthesizing the evidence from these randomized controlled trials, this review aims to provide clinicians with a clearer understanding of which strategies should change their clinical practices. Finally, this review also seeks to highlight gaps in the current literature, guiding future research and helping to establish more definitive clinical guidelines.