Sixty-three patients undergoing arthroscopic rotator cuff repair were randomized to receive either intravenous tranexamic acid (TXA) (n=32) or an equal volume of normal saline (n=31) 10 minutes preoperatively. The primary outcome of interest was arthroscopic visual clarity, assessed using a 3-grade visual clarity scoring system at four surgical stages: intra-articular soft-tissue procedures including synovectomy, acromioplasty, bursectomy, and greater tuberoplasty. Secondary outcomes included the need for medications to maintain hemodynamic stability, length of hospital stay, and incidence of thromboembolic events. Outcomes were assessed intraoperatively and postoperatively up to two weeks. Overall, the results revealed that the TXA group had significantly better visual clarity scores during intra-articular soft-tissue procedures, particularly synovectomy, but no significant improvement during the other surgical stages. There were no thromboembolic events in either group. These findings suggest that TXA can improve visual clarity, especially in patients with severe synovitis, without increasing thromboembolic risk.