BACKGROUND Topical application, oral and IV injection of Tranexamic acid (TXA) have been used to reduce surgical bleeding.OBJECTIVE To evaluate the safety and efficacy of TXA injected subcutaneously to reduce bleeding during dermatologic surgery.METHODS In this double-blinded, placebo controlled, randomized prospective study, 131 patients were randomized to subcutaneous injection of lidocaine 2% diluted 1:1 with either saline (placebo) or TXA 100mg/1ml prior to surgery. Before the second stage or closure, size measurements of bloodstain impregnation on Telfa and surgical wound size were recorded and analyzed using mixed-effects linear regression. Subjective evaluation of hemostasis was performed using 4-point scale grading and analyzed using Fischer's exact test.RESULTS 127 patients completed the study. The bloodstain to surgical wound size ratio was smaller in the TXA group (1.77) compared to the placebo group (2.49) (p<0.001). An improved effect of TXA on bleeding was observed in the subgroup of patients receiving anticoagulants (MD; 95% CI; -0.83; -1.20 to -0.46 p<0.001). The subjective hemostasis assessment was significantly better in the TXA group overall (p=0.043) and anticoagulant subgroup (p=0.001) compared to the placebo group. CONCLUSION Subcutaneous injection of TXA was safe, reduced bleeding during dermatologic surgery and particularly effective for patients receiving anticoagulation treatment.