Topical antifribrinolytic tranexamic acid (TXA) prevented postoperative bleeding when applied as an adjunct treatment to wounds of granulating defects after Mohs micrographic surgery (MMS), according to findings from a double-blind randomized controlled trial published in the Journal of the American Academy of Dermatology.

Investigators recruited patients undergoing MMS “with defects to heal by second intent” and randomly assigned them 1:1 to receive either TXA or placebo as adjuvant therapy for surgical wounds. The TXA group received a 25 mg/ml TXA-soaked nonadherent pad cut to the size of the granulation defect and applied directly to the defect. The control group received the same pad, soaked with normal saline instead of TXA. On postoperative day 2, investigators asked patients yes or no questions about postoperative bleeding and any perceived symptoms related to TXA.

There were 124 patients enrolled, with 62 in each group. The mean age overall was 72 years, and about 73% of patients in both groups were men. In the placebo group there were 6 (9.7%) patients who reported active bleeding within 48 hours postsurgery. In the TXA group, no patients reported bleeding within the same time period (P =.028). Neither group reported any perceived side effects.

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The study was limited by its small sample size, which did not allow for a sub-analysis of patients on anticoagulant therapy.

“Topical TXA is an inexpensive and easy addition to wound care in the setting of second intention surgical defects to reduce postoperative bleeding,” the study authors wrote.


Castillo B, Anokhin A, Golda N. Randomized study on the topical application of tranexamic acid to the wound bed of granulating defects for hemostasis in the setting of Mohs micrographic surgery. J Am Acad Dermatol. Published online August 29, 2022. doi:10.1016/j.jaad.2022.08.037

This article originally appeared on Dermatology Advisor