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Topical Tranexamic Acid Shows Efficacy for Postoperative Bleeding Reduction


Topical tranexamic acid is an effective wound care adjunct in reducing rates of postoperative bleeding of granulating defects in Mohs micrographic surgical settings.

Brianna Castillo, MD, of the University of Missouri in Columbia, and colleagues presented abstract data demonstrating the potential for adjuvant tranexamic acid (TXA) to reduce postoperative bleeding in granulating surgical wounds at the 2022 American College of Mohs Surgery Annual Meeting. Researchers performed a double-blind randomized controlled trial on the effectiveness of TXA in preventing bleeding in granulating surgical wounds. TXA is a drug that prevents blood clots from breaking down.1

“Postoperative bleeding is one of the more common complications when a wound is healing by second intent and can lead to patient distress and unnecessary return visits including possibly to emergency rooms after hours, thus generating increased cost to patients in the form of copays for emergency care,” the researchers wrote.1

According to Castillo and colleagues, TXA topical use can decrease intraoperative and postoperative bleeding in maxillofacial, orthopedic, and plastic surgeries It has been used as a topical hemostatic agent for superficial oral trauma and in anterior epistaxis, as well.1

The study enrolled 124 patients between October 1, 2020 and December 30, 2021. Each group had 62 patients. The study group consisted of patients with surgical defects that had a wound to heal who received 25mg/ml TXA-soaked pad, while the control group received a placebo of a saline-soaked pad. Both groups received standard petrolatum gauze pressure dressing overtop.1

Researchers gave patients wound care instructions and information on when to call their provider about bleeding questions. Patients received follow-up calls after 3 days to answer postoperative bleeding questions and to report any symptoms related to TXA treatment.

The study authors said no bleeding was reported in the TXA group that required patients to reference the provided wound care instructions or to call a provider, while the placebo group had 6 patients (9.7%) report bleeding within 48 hours after their surgeries.1 Researchers reported this as statistically significant, with a p-value of 0.028. There were no reports of perceived adverse effects among the 124 study participants.

“TXE is an inexpensive and easy topical preventative measure to consider adding to the wound care of granulating defects in the surgical setting. We have implemented this in our practice at the University of Missouri,” Castillo said at the conclusion of the presentation.


Castillo and her colleagues reported no relevant financial disclosures.


Castillo B, Anokhin A, Golda N. Randomized trial of topical tranexamic acid as wound care adjunct for hemostasis of granulating wounds in the setting of Mohs micrographic surgery. Presented at: 2022 American College of Mohs Surgery Annual Meeting; May 12-15, 2022; Philadelphia, Pennsylvania.

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