iarjsIARJSIARJS2789-610210.47310/iarjs.2025.v05i01.013Effects of Tranexamic Acid in Major Orthopedic Surgical Procedures: A Systematic ReviewBackground: Major orthopedic surgical procedures, such as total joint arthroplasty, spinal surgeries and fracture fixations, are frequently associated with significant blood loss, contributing to increased perioperative morbidity, transfusion requirements and healthcare burden. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has been increasingly adopted to reduce surgical bleeding. Objective: This systematic review aims to evaluate the efficacy and safety of TXA in minimizing perioperative blood loss and transfusion needs in major orthopedic surgeries and to examine the associated risk of thromboembolic complications. Methods: A comprehensive literature search was conducted using PubMed, Cochrane Library and Scopus up to April 2025. Relevant randomized controlled trials, systematic reviews and meta-analyses examining the use of TXA in total knee and hip arthroplasty, spine surgeries and orthopedic trauma procedures were included. Results: TXA was consistently associated with significant reductions in intraoperative and postoperative blood loss and transfusion requirements across various orthopedic procedures. Both intravenous and topical TXA demonstrated comparable efficacy. No significant increase in thromboembolic events was observed, supporting the drug's safety when appropriately administered. Limited but promising evidence exists for the use of TXA in pelvic and trauma-related fracture surgeries. Conclusion: Tranexamic acid is an effective and safe pharmacologic agent for perioperative blood conservation in major orthopedic surgeries. Its inclusion in surgical protocols can improve clinical outcomes and reduce transfusion-related risks. Further high-quality trials are required to validate its use in emergency trauma settings and to optimize individualized dosing strategies.