150 patients with lumbar degenerative disease and scheduled for a posterior lumbar interbody fusion procedure were randomized to receive intravenous TXA, topical TXA or placebo for blood loss. Outcomes of interest included hemoglobin, hematocrit and fibrinogen levels, prothrombin time, extubation time, hospital length of stay, post-operative Visual Analog Scale (VAS), intra-operative blood loss, drainage volume, visible and hidden blood loss volume, and post-operative blood transfusion. The study results displayed significantly favourable outcomes in the IV and topical TXA groups compared to the control group in hemoglobin and hematocrit levels, extubation time, hospital length of stay, intra-operative blood loss, drainage volume, visible and hidden blood loss, and blood transfusion. Moreover, the IV TXA group outperformed the topical TXA group in hemoglobin and hematocrit levels, intra-operative blood loss, as well as visible and hidden blood loss.