Bone and soft tissue bleeding often results in substantial amounts of blood loss during the total knee arthroplasty(TKA). Multiple studies have reported that cumulative blood loss varies from 500 to 1500 mL in primary settings. Increased perioperative blood loss frequently requires allogeneic blood transfusions to improve the hematocrit and hemoglobin levels. However,allogeneic transfusion is associated with risks of immunosuppression,transfusion reactions,graft versus host disease,and transmission of infec-tions. To avoid these problems and reduce costs of transfusion,multiple intraoperative pharmacotherapeutic strategies have been developed. The various pharmacotherapeutic agents currently used include tranexamic acid,epsilon-aminocaproic acid,fibrin,thrombin,lavage with epinephrine,and norepinephrine. However, the relative efficacy and the cost-effectiveness of these agents may vary. Thus,the purpose of this study was to provide a brief overview of the relative efficacy of various intraoperative pharmacological methods cur-rently in use for decreasing blood loss following TKA and describe their potential complications associated with their application.