BACKGROUND: Obstetric haemorrhage still remains a leading cause of maternal mortality and morbidity. It accounts for over 25% of maternal deaths and morbidity irrespective of the mode of delivery with most occurring in the postpartum period. Tranexamic acid, a prohaemostatic agent has been investigated as an effective adjunct for the reduction of blood loss which has been widely used in various areas of medicine. Details concerning its efficacy, dose and route of administration plus its safety profile especially among high risk patients have however not been fully answered. OBJECTIVE: To determine the efficacy of tranexamic acid in the reduction of blood loss during elective caesarean section among women at high risk for postpartum haemorrhage. DESIGN: This was a randomised double blind placebo-controlled clinical trial METHODOLOGY: The study population comprised of one hundred and forty-eight women making up both the placebo and tranexamic acid group. All pregnant women with obvious risk factors for PPH who were billed to undergo elective delivery at the Jos University Teaching Hospital were included in the study after obtaining informed consent. The primary outcome measure was total estimated blood loss during and after elective caesarean section while the secondary outcome measures were incidence of blood loss greater than 1000mls and maternal side effect profile. Numerical variables were presented as mean ± standard deviation (SD), while categorical variables were presented as numbers and percentage. Chi-square test (X2 ) was used for comparison between groups for categorical variables while Student t-test was used for comparison between groups for continuous variables. A difference with a P value < 0.05 was considered statistically significant.