206 patients undergoing total knee arthroplasty were randomized to 6 different groups to determine the ideal dosage and mode of treatment for tranexamic acid. Patients were to receive an intraoperative dose of tranexamic acid given before tourniquet deflation (group 1), an intraoperative dose of tranexamic acid with an additional preoperative dose (group 2), an intraoperative dose of tranexamic acid with an additional postoperative dose (group 3), a preoperative dose, intraoperative dose, and postoperative dose of tranexamic acid (group 4), a single local application of tranexamic acid (group 5), or no tranexamic acid (group 6). The results of the study indicated that a single-dose of tranexamic acid was not as effective as the multi-dose regimes. A double-dose was the lowest amount necessary to result in significant outcomes, and a triple-dose of tranexamic acid produced the most effective reduction in drain loss and total blood loss.