70 patients scheduled for simultaneous bilateral total knee arthroplasty were randomized to administration of intravenous or topical tranexamic acid. The purpose of this study was to compare, primarily, haemostatic efficacy and safety between the two groups, perioperatively, as well as clinical outcomes at follow-up. The results of this trial demonstrated that the estimated total blood loss, postoperative blood drainage, and the incidence of transfusion were significantly lower in the topical TXA group compared to the IV TXA group. Clinical outcomes favoured the topical TXA group; however, these differences were no likely to be clinically significant.