120 patients undergoing hip replacement surgery were randomized to receive either intravenous tranexamic acid (IV TXA), intra-articular TXA (TXA local), or placebo. Outcomes of interest included postoperative hemoglobin and hematocrit decline, transfusion rates, and the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and wound infection rates. The results showed that perioperative blood loss was significantly lower in the TXA-treated groups compared to placebo. Specifically, mean postoperative hemoglobin and hematocrit drop showed significant differences favoring TXA treatment. Additionally, transfusion rates significantly varied among the groups, with fewer patients in the TXA-treated groups requiring additional transfusions compared to the placebo group. The topical (intra-articular) route was found to be superior to the intravenous route in reducing blood loss without increasing the incidence of DVT, PE, allergic reactions, or wound infections.