Ten randomized controlled trials including 1,295 patients undergoing total hip arthroplasty were included in this systematic review and meta-analysis comparing intravenous tranexamic acid (ivTXA) versus topical tranexamic acid (tTXA). Pooled outcomes of interest included intraoperative blood loss, hidden blood loss, hemoglobin decline, transfusion rate, drainage volume, wound complications, deep vein thrombosis, and length of hospital stay. ivTXA was associated with significantly lower intraoperative and hidden blood loss, as well as reduced maximum hemoglobin drop. No significant differences were observed for transfusion rate, total blood loss, or complication rates. These findings suggest that both methods are effective and safe, but ivTXA may offer better intraoperative bleeding control.