89 patients scheduled for thoracolumbar fusion were randomized to either oral tranexamic acid or intravenous tranexamic acid. The oral group was assessed for equivalence relative to the intravenous group for hemoglobin drop and calculated blood loss. Additionally, patients were assessed for transfusion rate and venous thromboembolic complication rate. Equivalence was demonstrated for the oral group compared to the intravenous group for both hemoglobin drop and calculated blood loss. Transfusion rate and VTE rate did not significantly differ between groups.