A total of 120 patients undergoing spinal surgery were randomized to receive either 1.5 g of oral tranexamic acid (n=60) or a placebo (n=60) 2 hours before surgery. The primary outcome of interest was intraoperative blood loss. Secondary outcomes included postoperative blood loss, hospital stay length, incidence of nausea or vomiting, and postoperative coagulation measures such as hemoglobin levels, prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR). Outcomes were assessed during surgery and within 24 hours postoperatively. Overall, results revealed that the tranexamic acid group experienced significantly lower intraoperative and postoperative blood loss, along with shorter hospital stays, compared to the placebo group. However, the incidence of nausea or vomiting was higher in the tranexamic acid group. These findings suggest that oral tranexamic acid effectively reduces surgical blood loss and hospital stays in spinal surgery, with manageable side effects.