Two hundred and two patients with osteoarthrosis or rheumatoid arthritis undergoing a unilateral total knee arthroplasty were randomized to receive either one of the following interventions: 4 doses of Intravenous (IV) Tranexamic acid (TXA), 5 doses of IV-TXA, or 6 doses of IV-TXA or control (no TXA). The primary outcome of interest was hidden blood loss. Additional outcomes measured included the following: total blood loss (TBL), intraoperative blood loss (IBL), length of hospital stay (LOS), incidence of adverse events, fibrinolysis products, pain on a visual analogue scale (VAS), and inflammation markers. Outcomes were measured perioperatively, and up to 3-days post-surgery. Results revealed that the primary outcome of HBL was significantly in favour of 6-doses of IV-TXA compared to 2 other doses and the control. TBL was also significantly lower in the the group with 6 doses vs 2 other doses and control. Similarly, both inflammation markers and fibrinolysis parameters were significantly in favour of 6-doses of IV-TXA vs. the 4 and 5 TXA dose groups and control at all timepoints. VAS pain score was also significantly lower in the group with 6-doses of IV-TXA at all timepoints compared to the other 2 doses and control. No adverse events or cases of blood transfusion were observed for any of the treatment arms or control. Finally, no significant differences were observed between all treatment arms and control for LOS.