AimThe aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo.MethodsA systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospective studies comparing the use of intravenous TXA in patients treated for hip fractures, in comparison with placebo. Review Manager was used for the meta-analysis.ResultsEighteen prospective studies including 14 RCTs met the eligibility criteria. The results favored the TXA group in the quantity of total blood loss (MD =  − 196.91 mL, 95% CI − 247.59, − 146.23,I2= 92%), intraoperative blood loss (MD = − 26.86 mL, 95% CI − 36.96, − 16.78,I2= 62%), and rate of blood transfusion (OR 0.35, 95% CI 0.28, 0.42,I2= 0%). TXA also exhibited higher hemoglobin level at day 1 (MD = 6.77 g/L, 95% CI 4.30, 9.24,I2= 83%) and day 3 (MD = 7.02 g/L, 95% CI 3.30, 10.74,I2= 82%) postoperatively. There was no significant difference found in the incidence of thromboembolic events from occurring between the two groups, such as deep vein thrombosis (OR 1.22, 95% CI 0.73, 2.02,I2= 0%) and pulmonary embolism (OR 0.82, 95% CI 0.33, 2.05,I2= 0%).ConclusionAdministration of intravenous TXA appears to reduce blood loss, rate of blood transfusions and pose no increased risk of thromboembolic events. Therefore, TXA should be considered by physicians when managing hip fracture patients.Graphical abstractSupplementary InformationThe online version contains supplementary material available at 10.1007/s00590-022-03387-9.