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To determine if tranexamic acid could reduce the drainage duration after head and neck procedures.Prospective, randomized, controlled trial.Patients who underwent head and neck operations were included. The study group was treated with tranexamic acid during the perioperative period whereas the control group received normal saline solution. Blood samples were also collected.The study and control groups consisted of 26 and 29 patients, respectively. Although there was a significant difference in the drainage amount between the two groups, (49.7 vs 88.8 mL, P = 0.041), no significant difference could be found in the drainage duration between the two groups (2.69 vs 3.07 days, P = 0.146). There was also no significant difference in the coagulation profiles between the two groups.We did not find a meaningful effect in reducing the drainage duration after head and neck procedures with the use of prophylactic tranexamic acid.