40 patients undergoing total knee arthroplasty were randomized to an extended oral tranexamic acid post-operative protocol or a placebo protocol. The outcomes of interest included pain on a Visual Analog Scale (VAS), knee function and health scores (Knee Injury and Osteoarthritis Outcomes Score Joint Replacement [KOOS JR]), knee flexion, terminal knee extension, hemoglobin levels, and adverse events. Follow-up was performed up to 6 weeks post-operation. The extended tranexamic acid group demonstrated lower pain scores at 2 and 6 weeks, improved knee flexion at 6 weeks, and better KOOS JR scores at 2 and 6 weeks compared to the placebo group. No differences in hemoglobin levels or terminal knee extension were observed, and no adverse events were reported in either group.