Four randomized controlled trials including 717 patients undergoing spine surgery were included in this systematic review and meta-analysis comparing oral versus intravenous tranexamic acid (TXA). Pooled outcomes of interest included intraoperative and total blood loss, hemoglobin and hematocrit drop, transfusion rates, postoperative drainage volume, and complications such as DVT and infection. The pooled results showed no significant differences between oral and intravenous TXA in blood loss, hemoglobin/hematocrit levels, or transfusion rates. Oral TXA showed a statistically significant but clinically modest reduction in postoperative drainage volume. The findings suggest that oral TXA is as effective and safe as intravenous TXA and may offer advantages in cost and ease of use.