Background: Topical application of tranexamic acid (TXA) to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications. TXA decreases blood loss and, therefore, may minimize pain. Objective: To know the efficacy and safety of tranexamic acid intravenous overdose administration in primary total knee arthroplasty. Case study: We reported a 53 years old Saudi female ambulatory with no assisting aid and was not known to have any medical illnesses, presented to the orthopedic clinic complaining of bilateral knee pain and difficulty to ambulate for long distances for the last 5 years. This complain gradually worsened since last 2 years with no history of trauma prior to presentation or even after the follow up. The pain was localized at the knee joints and it was sharp in nature. The pain used to improve with rest and paracetamol intake and aggravated while standing or walking for long period of time. She was treated surgically by total knee arthroplasty, however during the operation by mistake she was given 4000 mg of tranexamic acid through IV route instead of topical application. Conclusion: Administration of 4000 mg of tranexamic acid through IV route is unusual but it seems to be safe without side effect on the patient in the early postoperative period.