Effect of Subcutaneous Tranexamic Acid on Hemostasis and Ecchymosis in Oculofacial Procedures: A Double-Blind, Placebo-Controlled, Randomized Trial

PURPOSE: The aim of this study was to assess the hemostatic effect of local tranexamic acid (TXA) in varied oculofacial procedures. METHODS: This is a prospective, randomized, placebo-controlled, double-blind study of 3,234 consecutive patients undergoing oculofacial procedures by a single surgeon (RS) between July 2020 and July 2024. Institutional review board approval was obtained. Patients undergoing unilateral procedures were randomized to either receive local anesthesia with or without TXA, with a concentration of 10 mg TXA/1 ml local anesthetic. For bilateral procedures (e.g., upper blepharoplasty), patients were randomized to receive local TXA solution in 1 eyelid while the contralateral lid received a placebo. Cautery was used in upper blepharoplasty, dacryocystorhinostomy, and lacrimal gland biopsy. Primary outcomes of the study included the duration of surgery, duration of cautery for specific procedures, degree of ecchymosis on postoperative day 7, and days until ecchymosis resolved. RESULTS: Treatment groups for all procedures were similar in terms of gender, age, medical history, and ultimate histopathologic diagnosis when biopsy was performed. Duration of cautery and surgery, ecchymosis grade on postoperative day 7, and duration to ecchymosis resolution were all significantly decreased for the patients treated with TXA for all surgical procedures. No complications, including thromboembolic events, were noted in the TXA group. CONCLUSION: TXA in local anesthetic proved safe and effective at reducing bleeding, surgical time, and ecchymosis at postoperative day 7, with a shorter overall duration of ecchymosis in this cohort.