Background <p>The objective of this systematic review and meta-analysis was to assess the effects of tranexamic acid (TXA) on bleeding and thromboembolic events in orthognathic surgery out.</p> Methods <p>Three electronic databases (PubMed, Web of Science, and Cochrane Library) were searched until 01/06/2024.</p> Results <p>Nine randomised controlled trials and two cohort studies were included for pooled analysis. Compared with the control group, the TXA group showed a mean reduction in intraoperative blood loss of 171.30 ml (p &lt; 0.00001; 95% CI, 197.58-145.02 ml). Systemic tranexamic acid use was associated with reduced operative time by a mean of14.5 minutes (p &lt; 0.0001; 95% CI, 20.89-8.02 mins) and reduction in the need for transfusion OR= 0.33 (p &lt; 0.01; 95% CI, 0.14-0.77).</p> Conclusion <p>This systematic review and meta-analysis supports the prophylactic use of tranexamic acid during orthognathic surgery in reducing blood loss, operative time and the risk of needing blood transfusions without increasing risk of thromboembolic complications.</p> Level of Evidence I <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>