84 patients with a high-energy fracture of the pelvis or femur and scheduled for open reduction and internal fixation were randomized to perioperative intravenous tranexamic acid (TXA) or no tranexamic acid (control). Patients were assessed for calculated total blood loss, transfusion rate, number of units transfused, postoperative drop in hematocrit, and incidence of venous thromboembolic complications. Despite a significantly smaller drop in hematocrit in the TXA group, no significant differences between groups were observed in calculated total blood loss and transfusion rate. However, there were trends towards improved blood conservation with the use of TXA in these patient populations.