One hundred and twenty patients with a diagnosis of primary osteoarthritis (OA) scheduled for unilateral total knee arthroplasty were randomized to receive either a combination of topical and intravenous administration of tranexamic acid, topical administration alone, or a saline control. Initial hemoglobin levels and postoperative drop, total drain amount, total blood loss, and transfusion rate were assessed 1 and 3 days postoperatively. Results indicated that the combined treatment and topical treatment alone both are viable treatment options compared to the control, with the combined group displaying potential as the superior treatment.