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Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery

A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Zilinsky, Isaac, MD*; Barazani, Tami Brutman, PhD; Visentin, Denis, PhD; Ahuja, Kiran, PhD; Martinowitz, Uriel, MD; Haik, Josef, MD§,║

doi: 10.1097/DSS.0000000000001786
Original Article
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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.

*Mohs Unit, Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

The National Hemophilia Center and Thrombosis Institute, Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia;

§Burns Unit, The Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel;

Burn Injury Research Node, Institute for Health Research, University of Notre Dame Fremantle, Fremantle, Western Australia, Australia

Address correspondence and reprint requests to: Josef Haik, MD, Burns Unit, The Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, 52621, Israel, or e-mail: josek.haik@gmail.com

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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