46 randomized controlled trials were included in this meta-analysis to investigate the use of tranexamic acid (TXA) in major orthopaedic surgery. The purpose of this analysis was to determine if blood loss and transfusion requirements were reduced with the application of TXA. Results revealed that intraoperative, postoperative and total blood loss were significantly reduced with tranexamic acid. Transfusion requirements, including mean number of units and volume, were also significantly reduced. The incidence of deep vein thrombosis was similar between groups.