Two hundred patients with intertrochanteric hip fractures were randomized to receive either a single preoperative dose of IV tranexamic acid (15 mg/kg in 100 ml saline, n=100) or placebo (100 ml saline, n=100). The primary outcome was frequency of perioperative allogenic blood transfusion. Secondary outcomes included perioperative hemoglobin changes, number of transfusion packs required, and post-operative complications. Outcomes were assessed during hospitalization and at 12 weeks follow-up. Overall, the results of the study revealed that patients in the TXA group had a significantly lower transfusion rate, fewer transfusion units required, and less hemoglobin decline on postoperative days one and two. Complication rates were comparable between groups. Preoperative TXA significantly reduced transfusion needs without increasing complications in dynamic hip screw (DHS) surgery for intertrochanteric fractures.