Patients and methods: This was a prospective double-blinded multi-center randomized controlled trial conducted from April 2022 till September 2022 involving one hundred eighty women categorized into three categories, each   involving 60 females who received either tranexamic acid, etamsylate or placebo just after birth of the baby. Results: Loss of blood in tranexamic acid was the same as the blood loss in etamsylate and both were lower than the placebo group. The difference in hemoglobin after delivery in tranexamic acid individuals was the same as etamsylate group and both of them were lower than placebo group. The occurrence of postpartum hemorrhage and blood transfusion in tranexamic acid category and etamsylate category were significantly less than placebo. Conclusions: Etamsylate is an efficiently alternative agent for tranexamic acid in decreasing blood loss with lower side effects, therefore, it can be used instead of tranexamic acid in women with contraindications or anticipated to be have higher risk to develop tranexamic acid side effects.Trial registration number: PACTR202205750416982