Objective To investigate the clinical efficacy and safety of tranexamic acid for anemia patients before UKA operation. Methods We retrospectively analyzed the clinical data of preoperative anemia in patients with unilateral UKA between July 2018 and May 2019.Patients were divided into tranexamic acid group (receiving tranexamic acid treatment perioperatively) and control group (not receiving TXA treatment).The observation indicators included general patient information, preoperative coagulation function, drainage volume, hidden blood loss, changes in Hb and HCT before and 5 days after surgery, allogeneic transfusion rate, and incidence of thrombosis. Results In this study, 76 patients were included. The demographic data, general health status and preoperative status of coagulation function of the two groups were comparable. In tranexamic acid group，postoperative drainage volume was 77.55±23.56mL，hidden blood loss was104.68±34.82mL；in control group，postoperative drainage volume was 132.88±39.64mL，hidden blood loss was182.67±47.71 mL；postoperative drainage volume and hidden blood loss in the tranexamic acid group were lower than those in the control group (P < 0.05).The level of Hb and HCT in the tranexamic acid group was significantly higher than that in the control group (P < 0.05) on the first day after surgery（10.43±6.52 g/dL vs 9.32±7.13g/dL，P＜0.05；31.43±2.52% vs 26.32±3.13%，P＜0.05), and the difference in Hb and HCT between the two groups on the other 4 days was not statistically significant (P > 0.05). Three (3/34) patients in the tranexamic acid group received blood transfusion, while 12(12/39) patients in the control group received blood transfusion. The number of patients in the tranexamic acid group was significantly lower than that in the control group (P < 0.05), and there was no significant difference in the incidence of thrombosis between the two groups (P > 0.05).Conclusion Intravenous tranexamic acid can effectively reduce the amount of blood loss and reduce the rate of blood transfusion in patients with anemia before UKA, and does not increase the risk of postoperative deep venous thrombosis in the lower extremities.