Intravenous tranexamic acid (TEA) is used in total hip arthroplasty (THA) to reduce blood loss. Concern of increased thromboembolic risk has prompted the search for treatment alternatives. The Tranexamic Acid Comparison in Hip Replacement (TeACH-R) trial is a prospective randomized controlled trial comparing the efficacy of intravenous and topical TEA in reducing perioperative blood loss. For interim data analysis, 52 of the planned 144 participants had completed the initial phase of the TeACH-R trial. No significant differences were identified between the intravenous and topical TEA treatment arms for delta-hemoglobin (ΔHgb; 34.81±13.78 vs. 35.65±15.54 mg/dL; p=0.840), calculated blood loss (1548±509 vs. 1521±693 mL; p=0.873), or length of stay (55.0±11.44 vs. 54.5±20.1 hours; p=0.912). No participant required a blood transfusion or had a thromboembolic event postoperatively. Promising initial results support the use of topical TEA in THA, although therapeutic decisions should be made only once all data has been analyzed