This systematic review aimed to identify the effectiveness of intravenous tranexamic acid (TXA) administration in managing perioperative blood loss in patients undergoing spine surgery. The study design was a systematic review and meta-analysis. Quantitative articles were pooled in a statistical meta-analysis using the Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument. Twelve studies totaling 934 participants carried out between 1960 and 2013 were included in the review. Intraoperative blood loss showed statistically significant (P < .0001) blood loss in the control group compared with that in the treatment group. Perioperative blood loss was approaching significance for blood loss in the control group with an overall P = .067. TXA helps reduce perioperative blood loss for patients undergoing spine surgery. TXA should be administered to patients undergoing spine surgery when significant blood loss is anticipated.