200 patients scheduled for primary, navigated total knee arthroplasty were randomized to one of four groups: intravenous (IV) tranexamic acid administration, intraarticular (IV) TXA administration, combined IV-IA TXA administration, or administration of placebo saline. Patients were assessed for blood loss variables, included total blood loss, postoperative blood loss, haemoglobin and haematocrit drop, and transfusion rate during the perioperative period. The incidence of venous thromboembolic (VTE) complications and wound-related complications were documented. Overall, all three TXA groups demonstrated significantly lower blood loss and incidence of transfusion compared to the placebo group, with no significant differences between the TXA groups. No cases of symptomatic VTE complications were recorded.