One hundred patients with Tile B and C pelvic fractures undergoing open reduction and internal fixation were randomized to receive either intravenous tranexamic acid (TXA) 15 mg/kg in 40 mL saline twice, 3 hours apart (n=50), or an equal volume of saline as placebo (n=50). The primary outcome was total perioperative blood loss. Secondary outcomes included hemoglobin and hematocrit changes, transfusion rate and volume, operative time, drain output, and hospital stay. Outcomes were assessed up to 3 days postoperatively and followed for thromboembolic events for at least 12 months. Overall, the results revealed significantly lower total blood loss, transfusion rate, and hospital stay in the TXA group without an increase in thromboembolic complications. These findings suggest that intravenous TXA is effective and safe for reducing blood loss and transfusion needs in pelvic fracture surgery.