One hundred eleven patients undergoing primary unilateral total knee arthroplasty were randomized to receive intravenous TXA (n=37), oral TXA (n=37), or topical TXA (n=37). The primary outcomes of interest were 24-hour hemoglobin loss, calculated blood loss, and blood transfusion rate. Secondary outcomes included length of hospital stay, ambulation rate on postoperative day 0, maximum ambulation distance on postoperative day 1, and maximum knee flexion on postoperative day 1. Outcomes were assessed within the first 24 hours postoperatively. Overall, the results of the study revealed no statistically significant differences among the three groups for hemoglobin loss (P=.79), calculated blood loss (P=.61), or transfusion rates (0% in all groups). The study concluded that all three TXA administration routes are similarly effective, but oral TXA is more cost-effective, despite potential logistical challenges in timing.