Two hundred and twenty-eight patients with primary total hip arthroplasty were randomized to receive either oral tranexamic acid (oral TXA; n=114) or 1 g of intravenous TXA (IV TXA; n=114). The primary outcome of interest was total blood loss (TBL) intra-operatively and up to 48 hours postoperatively. Secondary outcomes included a hemoglobin concentration decrease, D-Dimer levels on days 1 and 3, and transfusion rates. Outcomes were assessed up to 48 hours post-surgery. Overall, the study revealed that oral TXA is non-inferior to intravenous TXA regarding TBL, with the median difference between groups being within the noninferiority margin. The findings suggest that oral TXA can be an effective alternative to intravenous administration in reducing peri-operative blood loss in hip arthroplasty.