Subcutaneous injection of tranexamic acid with lidocaine reduced bleeding during Mohs micrographic surgery, with a greater reduction found in patients on anticoagulants, according to research in Dermatologic Surgery.
“This work presents a method to minimize the increased bleeding in patients under anticoagulation treatment by locally propagating [the] coagulation effect,” Isaac Zilinsky, MD, of the Mohs Unit, Sheba Medical Center at Tel Hashomer, Israel, and colleagues wrote.
Study subjects were undergoing Mohs micrographic surgery (MMS) for head and neck skin cancer. Sixty-four patients in the double-blind study randomly received a subcutaneous injection of 2% lidocaine with tranexamic acid (TXA) 100 mg/1 mL, while the placebo group encompassed 67 patients who randomly received a subcutaneous injection of 2% lidocaine with normal saline 0.9% sodium chloride in a 1:1 mixture.
After the first stage of MMS, a routine hemostasis was performed, the surgical wound was covered, and the patient was transferred to a waiting area for 30 minutes. After this, the patient returned to the surgical unit for the next step of the procedure, the dressing was removed, and wound measurements were taken.
In the TXA group, the surgical wound size was significantly larger than in the placebo group. No difference was found in the bloodstain size between the groups. The ratio of bloodstain to surgical wound size was smaller in the TXA group (95% CI, –0.72; –1.09 to –0.35).
Patients in the TXA group on anticoagulants had an increased effect and showed significantly lower bloodstain size to surgical would size when compared with the placebo group (95% CI, –0.83; –1.20 to –0.46). Those not on anticoagulants in the TXA group had significantly smaller bloodstain size to wound size than those in the placebo group (95% CI, –0.60; –1.18 to –0.01).
The surgeon’s assessment of which injection was given was correct in 63.3% of cases for the TXA group (P = .001) compared with 32.8% of cases for the placebo group.
“The decrease in bloodstain-to-defect ratio and significantly improved hemostasis assessment for subcutaneous TXA injection is due [to] reversibly blocking plasminogen-binding sites preventing activation to plasmin and lysis of polymerized fibrin in clotting,” the researchers wrote.
The use of TXA with an anesthetic allows for improved control of bleeding during and after surgery and may cause less of a burning sensation during injection, the researchers said. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.