Blood loss during total knee replacement (TKR) remains a significant concern. The purpose of this study is to compare the effect of systemic use versus local use of tranexamic acid on blood loss and transfusion requirements in total knee replacement. Tranexamic acid (TXA) is an effective hemostatic agent used for the reduction of blood loss and transfusion. However, the safety profile of TXA remains in question due to a potential increased risk of venous thrombosis. Patients and methods: In this study, 80 patients underwent TKR, and were divided into two groups based on whether they received a systemic tranexamic acid intra-operatively, or a local infiltration of tranexamic acid. Groups were then compared for mean calculated total blood volume (TBV) loss, transfusion rates, and knee range of movement. Results: The groups were compared after TKA, and the results showed that Mean TBV loss was similar between groups: systemic tranexamic acid use mean was 705 ml (281 to 1744), local use mean was 712 ml(261 to 2308) (p = 0.929). Conclusions: no statistical difference between the two groups on decreasing blood loss and transfusion requirement in TKA