Positives

• In a triple anticoagulant protocol that included a fibrinolytic component, 24 Long COVID patients reported resolution of shortness of breath, brain fog, and fatigue over 3-4 weeks alongside near-normal microclot scores, per a Health Rising coagulation report.
  
  
• Patients with Long COVID-associated heavy menstrual bleeding describe substantial reductions in flow on tranexamic acid, often by 26-60%, per a PMC review on heavy menstrual bleeding.
  
  

Negatives

• Researchers caution that tranexamic acid alone is hazardous in COVID's hypercoagulable state and could cause lethal thrombosis, leading patients with clotting symptoms to feel worse rather than better, per a PMC consideration paper.
  
  
• Patients commonly describe nausea, headache, leg cramps, and visual changes, with rare retinal events forcing discontinuation, per Mayo Clinic's tranexamic acid monograph.
  
  

Hurdles & Side Effects

• If used for the microclot theory, patients are advised to take it only alongside an anticoagulant such as a DOAC, requiring a clinician comfortable with off-label triple therapy, per a clinic protocol document.
  
  
• Insurance only covers tranexamic acid for menorrhagia or surgical bleeding, leaving Long COVID patients paying out of pocket and finding very few prescribers willing to use it for microclots, per a Gavi VaccinesWork article on microclots.