Total hip arthroplasty (THA) may produce blood loss requiring allogenic blood transfusion. Recently several authors have reported success decreasing their transfusion rate with tranexamic acid (TXA). We retrospectively reviewed our last 1595 primary THA in 1494 patients looking at whether the patients received TXA via IV infusion, topical application, or neither, and the need for a blood transfusion. Infusion of TXA acid produced a statistically significant difference in transfusion rate (p < 0.001) while topical TXA failed to reach statistical significance (P = 0.15). The transfusion rate without TXA was 19.86%, 4.39% with TXA infusion (odds ratio = 5.36), and 12.86% (odds ratio = 1.67) with topical TXA.