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130327 - Subcutaneous injection of tranexamic acid to reduce bleeding during dermatologic surgery - A double-blind, placebo-controlled, randomized clinical trial (author version).pdf (320.44 kB)

Subcutaneous injection of tranexamic acid to reduce bleeding during dermatologic surgery: A double-blind, placebo-controlled, randomized clinical trial

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posted on 2023-05-20, 00:01 authored by Zilinsky, I, Barazani, TB, Denis VisentinDenis Visentin, Kiran AhujaKiran Ahuja, Martinowitz, U, Haik, J

Background: Topical application, oral, and IV injection of tranexamic acid (TXA) have been used to reduce surgical bleeding.

Objective: To evaluate the safety and efficacy of TXA injected subcutaneously to reduce bleeding during dermatologic surgery.

Methods: In this double-blinded, placebo-controlled, randomized prospective study, 131 patients were randomized to subcutaneous injection of lidocaine 2% diluted 1:1 with either saline (placebo) or TXA 100 mg/1 mL before surgery. Before the second stage or closure, size measurements of bloodstain impregnation on Telfa and surgical wound size were recorded and analyzed using mixed-effects linear regression. Subjective evaluation of hemostasis was performed using 4-point scale grading and analyzed using Fischer's exact test.

Results: One hundred twenty-seven patients completed the study. The bloodstain to surgical wound size ratio was smaller in the TXA group (1.77) compared with the placebo group (2.49) (p < .001). An improved effect of TXA on bleeding was observed in the subgroup of patients receiving anticoagulants (mean difference; 95% confidence interval; -0.83; -1.20 to -0.46 p < .001). The subjective hemostasis assessment was significantly better in the TXA group overall (p = .043) and anticoagulant subgroup p = .001) compared with the placebo group.

Conclusion: Subcutaneous injection of TXA was safe, reduced bleeding during dermatologic surgery, and particularly effective for patients receiving anticoagulation treatment.


Publication title

Dermatologic Surgery








School of Health Sciences


Blackwell Publishing Inc

Place of publication

350 Main St, Malden, USA, Ma, 02148

Rights statement

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form as the article cited above.

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Socio-economic Objectives

Treatment of human diseases and conditions

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