One hundred four patients with hemophilic arthritis underwent total knee arthroplasties and were randomized to receive either tranexamic acid (TXA) (n=52) or no TXA (n=52). All patients received modified coagulation factor substitution therapy and mechanical prophylaxis (no chemoprophylaxis). The primary outcome was the incidence of deep venous thrombosis (DVT), with secondary outcomes including blood transfusion rates, postoperative drainage, and complications such as hemarthrosis and infection. Outcomes were assessed via ultrasound on days 3 and 14 postoperatively and clinical follow-up at 3, 6, 12, and 24 months. Overall, the results revealed no DVT events in either group during the 2-year follow-up. Additionally, TXA significantly reduced the need for blood transfusions and postoperative drainage. These findings suggest that TXA can be safely administered in hemophiliacs undergoing TKA without elevating the risk of DVT.