50 patients undergoing unilateral total knee arthroplasty without a pneumatic tourniquet were randomized to receive tranexamic acid (TXA) perioperatively or placebo. The purpose of this study was to evaluate the safety and efficacy of TXA in patients being operated without a tourniquet, as compared to a placebo-controlled group. Total blood loss, rate of transfusion, and hematocrit and hemoglobin levels were measured up to 3 days following surgery, while incidence of adverse events was recorded up to 6 months postoperatively. The results of this trial indicated that the application of tranexamic acid effectively lowered blood loss and rate of transfusion as compared to the placebo group.