One hundred and sixty-five elderly patients scheduled to receive a cemented hemiarthroplasty for a subcapital hip fracture (n=64) or intramedullary nailing procedure for intertrochanteric fracture (n=101) were randomized to receive intravenous tranexamic acid (TXA; n=77) or a normal saline placebo (n=88) for the reduction of blood loss and transfusion rates. Outcomes of interest included total blood loss, total hemoglobin loss, transfusion rate, number of transfused red blood cell units, the incidence of mortality, and the incidence of life-threatening complications. Transfusions, blood loss, and hemoglobin loss were measured up to the 4th post-operative day. Results revealed statistically significantly lower total blood loss and total hemoglobin loss in the TXA group compared to the placebo group (p>0.05 for all). However, in the subgroup analysis by fracture type, only in the intertrochanteric fracture group was the total blood loss and total hemoglobin loss statistically significantly lower in the TXA group (p>0.05 for all). In the overall analysis, transfusion rate and mean transfused red blood cell units were statistically significantly lower in the TXA group compared to the placebo group (p=0.035). Two deaths in the TXA group and 1 death in the placebo group were recorded. No cases of life-threatening complications were seen in the immediate post-operative period.