Painter TW, et al. - In this investigator-initiated, prospective, randomised, double blind placebo-controlled trial, researchers compared intravenous (IV) tranexamic acid (TA) vs placebo with respect to bleeding and the risk of allogenic blood transfusion in 140 patients, aged 45 years or older, undergoing elective primary or revision hip or knee joint replacement. The feasibility of extending this trial methodology to a large trial of TA in this population was also investigated. Although a lower rate of transfusion was documented as compared to that widely reported, IV TA attenuated transfusion in patients undergoing lower limb arthroplasty. Also, findings revealed the feasibility of their trial methodology in the setting of a large multicentre study to investigate if TA is safe and reduces bleeding in lower limb arthroplasty.