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Objectives: To explore the efficacy and safety of tranexamic acid at caesarian section (CS)., Study Design: Prospective, randomized, case-controlled clinical trial., Population: One hundred and eighty primiparas were randomized into two groups. The study group, 91 women, received tranexamic acid immediately before CS whereas the control group, 89 women did not., Method: Blood was collected during two periods. The first period was from placental delivery to the end of CS and the second was from the end of CS to 2 h postpartum. The quantity of blood was measured and compared between the two groups. Complete blood count, urinalysis, liver and renal function, prothrombin time and activity, were tested in the two groups., Results: Tranexamic acid significantly reduced the quantity of blood from the end of CS to 2 h postpartum: 42.75 +/- 40.45 ml in the study group versus 73.98 +/- 77.09 ml in the control group (P=0.001). It also significantly reduced the quantity of total blood from placental delivery to 2 h postpartum: 351.57 +/- 148.20 ml in the study group, 439.36 +/- 191.48 ml in the control group (P=0.002). No complications or side effects were reported in either group., Conclusions: Tranexamic acid statistically reduces the extent of bleeding from placental delivery to 2 h postpartum and its use was not associated with any side effects or complications. Thus, tranexamic acid can be used safely and effectively to reduce bleeding resulting from CS.