54 studies (comprising 59 randomized controlled trials with 3402 patients) were included in this meta-analysis comparing the use of either intravenous tranexamic acid (TXA) or intravenous epsilon aminocaproic acid (EACA) to placebo in reducing blood loss in orthopaedic surgery. TXA was observed to significantly reduce intraoperative, postoperative, and total blood loss while reducing transfusion rate compared to placebo. EACA was observed to significantly reduce postoperative and total blood loss, although its effects on intraoperative blood loss and transfusion rate were uncertain. In either case, neither TXA or EACA were associated with an increased risk of thromboembolic events.