Timing of Subcutaneous Tranexamic Acid Injection in Mohs Micrographic Surgery

Timing of Subcutaneous Tranexamic Acid Injection in Mohs Micrographic Surgery: A Prospective, Multicenter, Two-Arm, Non-Inferiority Trial

This study will compare postoperative bleeding after subcutaneous tranexamic acid (TXA) is administered during Mohs surgery either after tumor clearance and before reconstruction or after reconstruction and before bandage application. TXA is a medication already being administered selectively during Mohs to help lessen bleeding. Enrollment will be enriched for patients taking anticoagulant or antiplatelet therapy and for patients receiving flaps or grafts because these groups have higher bleeding risk; although, any patient receiving Mohs with a linear closure, flap, or graft, may enroll. The primary hypothesis is that pre-reconstruction TXA is no better or worse compared to post-reconstruction TXA when measuring bleeding events within 48 hours and surgical complications within 30 days.

Inclusion Criteria:

1. Age 18 years or older.
2. Undergoing MMS at a participating site with a planned same-day linear closure, flap reconstruction, or graft reconstruction.
3. Willing and able to provide written informed consent.
4. Able to participate in standard postoperative follow-up and to be reached if follow-up clarification is required.

Exclusion Criteria:

1. Known allergy or hypersensitivity to TXA.
2. Active deep-vein thrombosis, pulmonary embolism, stroke, myocardial infarction, or other active thromboembolic event at the time of surgery.
3. Thromboembolic event within the previous 3 months.
4. Systolic blood pressure greater than 200 mmHg at the time of surgery.
5. Pregnancy or breastfeeding.
6. Planned second-intention healing without reconstruction.
7. History of seizures or current medication judged by the investigator to materially lower seizure threshold.
8. Reported serum creatinine of 5 mg/dL or greater.
9. Unable to complete the 48-hour outcome assessment or standard postoperative follow-up.
10. Prior enrollment in this study.