98 patients undergoing TKA or THA were randomized to receive a restrictive blood transfusion program either with an intraoperative intravenous 1.0 g dose of tranexamic acid (TXA) and a repeated dose 3 hours later or a placebo. Analysis revealed that a lower proportion of TXA patients required reinfusion of postoperatively collected autologous blood, in addition to a reduction in mean total external blood loss and blood drained in the first 24h after surgery. Blood pressures were not clinically impacted with TXA and were comparable with the placebo. No confirmed cases of pulmonary embolism, deep vein thrombosis, or seizures were reported in the TXA group.