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Total knee arthroplasty usually includes the use of tourniquet in order to induce ischemia during the surgery, resulting in unapparent intraoperative bleeding but substantial postoperative blood loss. Different factors may influence in the surgical bleeding in total knee arthroplasty like coagulation disorders, medication (antiagregants, NSAID, LMWH) and anesthetic technique. Allogeneic blood transfusion is associated with the blood loss during surgery and postoperative drainage, but also with the haemoglobin level before the surgery. Allogeneic blood transfusion is the standard approach to increase haemoglobin (Hb) concentration. But this procedure is not free of risks despite all efforts to avoid them. In addition to well-known risks, such as volume overload, mistransfusion, the transmission of infections, transfusion febrile reactions, transfusion-related acute lung injury, allergic transfusion reactions, or alloimmunization, there is increased morbidity and mortality, and longer hospital stays. These situations justify clinical strategies to minimize exposure to allogeneic blood transfusion. As hyper fibrinolysis is considered the major cause of postoperative bleeding after total knee replacement surgery, anti-fibrinolytic drugs have been proposed. Tranexamic acid (TXA) is a synthetic analog of serin than reversibly inhibits fibrinolysis by blocking lysine union sites in the plasmin and plasminogen activator molecules. It has been extensively used in cardiac surgery, urology, gynaecology, liver transplants and orthopaedic surgery. Only two-dose IV of tranexamic acid can be used in total knee replacement procedures with proven effectiveness and efficiency to decrease postoperative blood loss, decrease risk of allogeneic blood transfusion and decrease length of hospital stay in our patients undergoing total knee arthroplasty.(Raul Cordoba, Blanca Tapia, OlatzAramburu, Maria-Asuncion Mora, Rafael Bielza, Javier Escalera, Jose-Ignacio Lora-Tamayo and Luis Ercoreca, Tranexamic Acid Reduces Blood Transfusion, Postoperative Blood Loss)