123 patients undergoing posterior lumbar interbody fusion (PLIF) were randomized to receive either sequential perioperative intravenous tranexamic acid (TXA; n=63) or a saline control (n=59). The primary outcomes of interest included hidden blood loss (HBL) and postoperative blood loss (PBL). Secondary outcomes of interest included total blood loss (TBL), drainage removal time (DRT), length of stay (LOS), interleukin-6 (IL-6), C-reactive protein (CRP), hematocrit (HCT) and hemoglobin levels (Hb), TXA complications, liver and kidney function indicators, and coagulation function indicator levels. TBL, PBL, and HBL were significantly lower in the TXA group compared to the saline control. HCT and Hb levels, & coagulation function were similar among the two groups up to 5 postoperative days (POD). Changes in HCT and Hb, fibrinogen degradation products (FDP), and D-Dimer (D-D) were significantly better in the TXA group on POD 1 and POD3. IL-6 and CRP were also significantly better in the TXA group on POD1-5 and POD3-5, respectively.