[Objective] To Investigate the efficacy and safety of tranexamic acid (TXA) in different ways in the treatment of bleeding in patients with total knee arthroplasty (TKA). [Methods] 180 patients with TKA in our hospital from July 2016 to March 2019 were selected and randomly divided into A, B, C and control groups, each in group A was given TXA 1g by intravenous dripping, B group was given TXA 1 g by 5 min infiltration at the incision, C group was given intra-articular by injection, and the control group was given the same dose of saline vein by Instillation. The blood loss related data, coagulation parameters and incidence of postoperative complications were compared between the 4 groups. [Results] There was no significant difference of blood loss of the 4 groups (P>0.05). In group C, except the blood loss in the operation the other blood loss related indexes were the lowest, B group was the next, group A was higher, the control group was the highest, the difference was obvious (P<0.05); There was no obvious change of coagulation parameters in the 4 groups before and after operation (P>0.05), The wound healing of the four groups were good after operation, no infection and bad effect, no postoperative complications such as death and deep venous thrombosis of lower extremities (DVT) occurred. [Conclusion] The effect of hemostasis is obvious by using TXA in TKA patients. The blood loss has a significant correlation with the application way, and the effect of local articular cavity perfusion is the best. It is worthy of clinical application.