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Background: Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication., Methods: Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 each: placebo, low dose (bolus 10mg.kg -1 ), low dose+maintenance (bolus 10mg.kg -1 +maintenance 1mg.kg -1 .hr -1 ), high dose (bolus 30mg.kg -1 ) and high dose+maintenance (bolus 30mg.kg -1 +maintenance 3mg.kg -1 .hr -1 ). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperative period. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period., Results: The intraoperative blood loss was 440±207.54mL in the placebo group, 412.5±208.21mL in the low dose group, 290±149.6ml in the low dose plus maintenance group, 332.5±162.33mL in the high dose group and 240.7±88.15mL in the high dose maintenance group (p <0.001). The reduction in postoperative blood loss in the drain for the first 24hours was 80±44.44mL in the placebo group, 89.88±44.87mL in the low dose group, 56.7±29.12mL in the low dose plus maintenance group, 77.9±35.74mL in the high dose group and 46.7±19.9mL in the high dose maintenance group (p <0.001). DVT was not encountered in any patient., Conclusion: Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose+maintenance group., (Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)