Abstract Background: Spinal deformity surgeries are often associ-ated with a high incidence of perioperative blood loss, which poses several complications. Much current research focuses on the importance of antifibrinolytic drugs during spinal surgeries to reduce blood loss, which can also reduce the risk of the need for blood transfusions. We evaluated the effects of using high-dose tranexamic acid (TXA) in spinal deformity surgeries on blood loss, blood transfusions, and associated complications. Aim of Study: Assessing the efficacy of using Tranexamic acid in deformity spine surgery regarding blood loss and the need of blood transfusion. Patients and Methods: 20 patients with spine deformities that were surgically corrected in Cairo and Fayoum University hospitals between October 2023 and April 2024 were included. The patients were divided into 2 groups; Group A included pa-tients who received TXA intraoperative while Group B includ-ed patients who didn't receive TXA. The TXA regimen was 50mg/Kg as loading 15-20 min-utes pre-surgical incision then 20mg/Kg as a maintenance dose every hour till the end of surgery. Results: There were no significant differences between the study groups in terms of intraoperative blood loss, as the mean blood loss intra-operative in the TXA group was 0.8 L ± 0.4 L while in the control group, it was 0.85 L ± 0.4 L but there was significant difference in post-operative bleeding as Mean blood loss post-operative in TXA group is 0.31 L ± 0.06 L while in the control group was 0. 51 L ± 0.1 L. The median range of Packed red blood cells (PRBCs) or plasma transfusion intra-operative in both groups is 0 to 1.5. The median range of PRBCS or plasma transfusion post-operative is 0 in the TXA group, and 0 to 1 in the control group. The median time of drain removal in the TXA group was 2.5 days while 3 days in the control group. Conclusion: We found the use of TXA was effective in re-ducing surgical bleeding and postoperative transfusion volume for patients undergoing spinal deformity surgeries. However, there was not a statistically significant effect of TXA on the overall clinical outcome.