One hundred patients undergoing primary total knee arthroplasty (TKA) for primary osteoarthritis were randomized to receive either two-dose intravenous tranexamic acid (n=50) or placebo (n=50). The primary outcome of interest was total blood loss within 72 hours postoperatively. Secondary outcomes included intraoperative blood loss, postoperative blood loss, hidden blood loss, need for allogeneic blood transfusion, and perioperative complications such as wound infection and deep venous thrombosis (DVT). Outcomes were assessed for up to six months postoperatively. Overall, the study found a statistically significant reduction in total, hidden, and postoperative blood loss in the TXA group compared to the control group. However, this did not translate into a significant difference in allogeneic blood transfusion rates (p=0.640). Complication rates were similar between groups. The findings suggest that while TXA reduces blood loss, its clinical impact in experienced surgical settings may be limited.