Topical Tranexamic Acid Use on Granulating Wounds Following Mohs Micrographic Surgery

NCT ID: NCT04541303

Last Updated: 2024-11-21

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

EARLY_PHASE1

Total Enrollment

124 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-10-08

Study Completion Date

2021-12-30

Brief Summary

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Bleeding after Mohs micrographic surgery for skin cancer is a low risk complication that can occur. This study aims to determine the effect of a drug, often used to reduce bleeding, called tranexamic acid when applied topically to the skin wound after surgery.

Detailed Description

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To perform a prospective randomized controlled trial to determine the hemostatic effect of TXA soaked gauze (intervention) versus normal saline soaked gauze (control) when applied to granulating defects in the setting of Mohs micrographic surgery.

Patients meeting inclusion criteria will be randomized into two arms once enrolled in the study on the day of their Mohs micrographic surgery (MMS).

One arm will serve as the control group and will receive normal saline soaked telfa pads to the wound bed upon completion of MMS.

A second arm will receive TXA 25mg/ml at a volume of 1ml/cm2 soaked telfa pads to wound bed upon completion of MMS.

In both arms, the telfa pads will have a standard pressure dressing placed overtop.

Conditions

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Postoperative Wound Haemorrhage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

One arm will receive topical application of tranexamic acid (intervention). Other arm with receive topical application of normal saline (placebo).
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
Physician/surgeon, nurses, patient, and patient family will be blinded.

Study Groups

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Intervention

Topical application of tranexamic acid to granulating wound defect status post Mohs micrographic surgery.

Group Type EXPERIMENTAL

Tranexamic acid

Intervention Type DRUG

tranexamic acid diluted to concentration of 25ml/mg

Placebo

Topical application of normal saline to granulating wound defect status post Mohs micrographic surgery.

Group Type PLACEBO_COMPARATOR

normal saline

Intervention Type DRUG

0.9% sodium chloride

Interventions

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Tranexamic acid

tranexamic acid diluted to concentration of 25ml/mg

Intervention Type DRUG

normal saline

0.9% sodium chloride

Intervention Type DRUG

Other Intervention Names

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Lysteda Cyclokapron 0.9% sodium chloride

Eligibility Criteria

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Inclusion Criteria

* All adult (18 years or older) patients presenting for Mohs micrographic surgery (MMS) for the treatment of melanoma or nonmelanoma skin cancer (NMSC) with a wound that will be healing by granulation

Exclusion Criteria

* Patients must not be pregnant or breastfeeding.
* Patients must not have a known allergic reaction or sensitivity to TXA
* Patient must not have an international normalized ratio (INR) out of therapeutic range if on warfarin.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Missouri-Columbia

OTHER

Sponsor Role lead

Responsible Party

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Nicholas J Golda

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nicholas Golda, MD

Role: PRINCIPAL_INVESTIGATOR

University of Missouri-Columbia

Locations

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University of Missouri-Columbia

Columbia, Missouri, United States

Site Status

Countries

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United States

References

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Tolkachjov SN, Brodland DG, Coldiron BM, Fazio MJ, Hruza GJ, Roenigk RK, Rogers HW, Zitelli JA, Winchester DS, Harmon CB. Understanding Mohs Micrographic Surgery: A Review and Practical Guide for the Nondermatologist. Mayo Clin Proc. 2017 Aug;92(8):1261-1271. doi: 10.1016/j.mayocp.2017.04.009.

Reference Type BACKGROUND
PMID: 28778259 (View on PubMed)

Kimyai-Asadi A, Goldberg LH, Peterson SR, Silapint S, Jih MH. The incidence of major complications from Mohs micrographic surgery performed in office-based and hospital-based settings. J Am Acad Dermatol. 2005 Oct;53(4):628-34. doi: 10.1016/j.jaad.2005.03.023.

Reference Type BACKGROUND
PMID: 16198783 (View on PubMed)

Bunick CG, Aasi SZ. Hemorrhagic complications in dermatologic surgery. Dermatol Ther. 2011 Nov-Dec;24(6):537-50. doi: 10.1111/j.1529-8019.2012.01454.x.

Reference Type BACKGROUND
PMID: 22515669 (View on PubMed)

Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999 Jun;57(6):1005-32. doi: 10.2165/00003495-199957060-00017.

Reference Type BACKGROUND
PMID: 10400410 (View on PubMed)

Lin ZX, Woolf SK. Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery. Orthopedics. 2016 Mar-Apr;39(2):119-30. doi: 10.3928/01477447-20160301-05. Epub 2016 Mar 4.

Reference Type BACKGROUND
PMID: 26942474 (View on PubMed)

Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, Cook L, Kawahara T, Perel P, Prieto-Merino D, Ramos M, Cairns J, Guerriero C. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013 Mar;17(10):1-79. doi: 10.3310/hta17100.

Reference Type BACKGROUND
PMID: 23477634 (View on PubMed)

Kagoma YK, Crowther MA, Douketis J, Bhandari M, Eikelboom J, Lim W. Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials. Thromb Res. 2009 Mar;123(5):687-96. doi: 10.1016/j.thromres.2008.09.015. Epub 2008 Nov 12.

Reference Type BACKGROUND
PMID: 19007970 (View on PubMed)

Ausen K, Hagen AI, Ostbyhaug HS, Olafsson S, Kvalsund BJ, Spigset O, Pleym H. Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial. BJS Open. 2020 Apr;4(2):216-224. doi: 10.1002/bjs5.50248. Epub 2019 Dec 26.

Reference Type BACKGROUND
PMID: 32207575 (View on PubMed)

de Vasconcellos SJ, de Santana Santos T, Reinheimer DM, Faria-E-Silva AL, de Melo MF, Martins-Filho PR. Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials. J Craniomaxillofac Surg. 2017 Jan;45(1):20-26. doi: 10.1016/j.jcms.2016.10.001. Epub 2016 Oct 13.

Reference Type BACKGROUND
PMID: 27840121 (View on PubMed)

Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med. 2013 Sep;31(9):1389-92. doi: 10.1016/j.ajem.2013.06.043. Epub 2013 Jul 30.

Reference Type BACKGROUND
PMID: 23911102 (View on PubMed)

Teoh WY, Tan TG, Ng KT, Ong KX, Chan XL, Hung Tsan SE, Wang CY. Prophylactic Topical Tranexamic Acid Versus Placebo in Surgical Patients: A Systematic Review and Meta-analysis *. Ann Surg. 2021 Apr 1;273(4):676-683. doi: 10.1097/SLA.0000000000003896.

Reference Type BACKGROUND
PMID: 32282377 (View on PubMed)

Ausen K, Pleym H, Liu J, Hegstad S, Nordgard HB, Pavlovic I, Spigset O. Serum Concentrations and Pharmacokinetics of Tranexamic Acid after Two Means of Topical Administration in Massive Weight Loss Skin-Reducing Surgery. Plast Reconstr Surg. 2019 Jun;143(6):1169e-1178e. doi: 10.1097/PRS.0000000000005620.

Reference Type BACKGROUND
PMID: 31136475 (View on PubMed)

Eikebrokk TA, Vassmyr BS, Ausen K, Gravastrand C, Spigset O, Pukstad B. Cytotoxicity and effect on wound re-epithelialization after topical administration of tranexamic acid. BJS Open. 2019 Sep 26;3(6):840-851. doi: 10.1002/bjs5.50192. eCollection 2019 Dec.

Reference Type BACKGROUND
PMID: 31832591 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/022430s004lbl.pdf

Ferring Pharmaceuticals Incorporated. Lysteda (tranexamic acid) \[package insert\]. Revised October 2013. Accessed May 2020.

Other Identifiers

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2025444

Identifier Type: -

Identifier Source: org_study_id

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