Abstract Purpose: Anti-fibrinolytic agents such as tranexamic acid (TXA) have been widely utilized to reduce perioperative bleeding and transfusion after total joint arthroplasty. The aim of our study was to investigate whether epsilon-aminocaproic acid (EACA) as an alternative agent could exert superior performance to TXA in total hip arthroplasty(THA). Methods: From September 2019 to April 2020, a total of 99 patients who underwent unilateral total hip arthroplasty participated in this prospective randomized controlled trial. EACA group (n = 49) and tranexamic acid group (n = 50) both received intravenous and local combination of drugs. The primary outcomes were estimated blood loss (EBL), drainage, transfusion rates and units and hemoglobin level at postoperative day1 and day3. The secondary outcomes included hospitalization cost (￥, CNY), length of hospital stay(LOS), and postoperative complications. Results: No significant differences were observed with respect of EBL, drainage, hemoglobin level on postoperative days 1 or 3（P＜0.05）. Two patients in TXA group received blood transfusion. There were no statistically significant differences in hospitalization costs, length of postoperative hospital stay or postoperative complications between groups. Conclusion: Since no significant differences were seen in any haematological outcome measures or postoperative complications, we concluded that the EACA with intravenous and topical usage combined maybe competent to be an alternative to TXA on blood conservation in total hip arthroplasty.