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

<p><strong>Background:</strong> Topical application, oral, and IV injection of tranexamic acid (TXA) have been used to reduce surgical bleeding.</p> <p><strong>Objective:</strong> To evaluate the safety and efficacy of TXA injected subcutaneously to reduce bleeding during dermatologic surgery.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results:</strong> 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) (<i>p</i> < .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 <i>p</i> < .001). The subjective hemostasis assessment was significantly better in the TXA group overall (<i>p</i> = .043) and anticoagulant subgroup <i>p</i> = .001) compared with the placebo group.</p> <p><strong>Conclusion:</strong> Subcutaneous injection of TXA was safe, reduced bleeding during dermatologic surgery, and particularly effective for patients receiving anticoagulation treatment.</p>