Reducing or eliminating unnecessary allogeneic blood transfusions (ABT) through patient blood management (PBM) leads to improved patient outcomes, including reduced postoperative infection rates and length of stay. To be successful, a PBM program must include a multidisciplinary team with expertise to manage diverse issues such as diagnosis and treatment of anemia, optimization of hemostasis and education and engagement of stakeholders at all levels. ONTraC (Ontario Transfusion Coordinators) is a large Canadian PBM program that over its 10 year existence achieved significant reduction in ABT rates in the four targeted surgeries. Administration of tranexamic acid in joint replacement surgery is a useful PBM intervention as the drug has been shown to be effective in reducing ABT, affordable, easy to use and to have a favorable side effect profile. New oral anticoagulants are gaining popularity among physicians and doctors but may present unique diagnostic and management challenges in a perioperative patient.