60 patients scheduled for primary total knee arthroplasty (TKA) were randomized to one of four groups: combined intravenous and local tranexamic acid administration, intravenous TXA administration alone, local TXA administration alone, or placebo. The purpose of this study was to evaluate the efficacy of combined TXA administration in comparison to either administration route alone for reducing blood loss. Outcomes measured included blood loss to a postoperative drain, hemoglobin drop, and transfusion need. Drain blood loss was significantly lower in the combined group when compared to either exclusive administration group, along with a significantly smaller Hb drop.