Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

Table 2 TXA dose adaptations for patients with renal insufficiency for various indications

Indication for TXA	Patient	Recommended TXA dose		References
Menorrhagia	Minor RI	PERI	1.3 g 2x/d (max. 5 d)	[150, 151]
	Mild RI	PERI	1.3 g/d (max. 5 d)
	Severe RI	PERI	0.65 g/d (max. 5 d)
Orthopedic	Minor RI	PRE	10-15 mg/kg (max 1.2 g, over 30 min)	[151]
	Minor RI	PERI	11.25 mg/kg (8h and 16h after first dose)
	Mild RI	PRE	10-15 mg/kg (max 1.2 g, over 30 min)
	Mild RI	PERI	8.4 mg/kg (8h and 16h after first dose)
	Severe RI	PRE	10-15 mg/kg (max 1.2 g, over 30 min)
	Severe RI	PERI	6.3 mg/kg (8h and 16h after first dose)
Cardiac surgery	Low bleeding risk + minor RI	PRE	10-15 mg/kg	[151, 152]
	Low bleeding risk + minor RI	PERI	3.75 mg/kg/h continuous infusion
	Low bleeding risk + mild RI	PRE	10-15 mg/kg
	Low bleeding risk + mild RI	PERI	2.50 mg/kg/h continuous infusion
	Low bleeding risk + severe RI	PRE	10-15 mg/kg
	Low bleeding risk + severe RI	PERI	1.25 mg/kg/h continuous infusion
	High bleeding risk + minor RI	PRE	25-30 mg/kg
	High bleeding risk + minor RI	PERI	11-16 mg/kg/h continuous infusion
	High bleeding risk + mild RI	PRE	25-30 mg/kg
	High bleeding risk + mild RI	PERI	5-10 mg/kg/h continuous infusion
	High bleeding risk + severe RI	PRE	25-30 mg/kg
	High bleeding risk + severe RI	PERI	3-5 mg/kg/h continuous infusion
Minor oral surgery	Minor RI	POST	10 mg/kg 2x/d	[150, 151]
	Mild RI	POST	10 mg/kg 1x/d
	Severe RI	POST	10 mg/kg 1x/2d or 5 mg/kg 1x/d

with d day(s), min minutes, h hours, pre preoperative dose, peri perioperative dose, post postoperative dose, NS normal saline, RI renal insufficiency with minor RI when GFR = 60-89 mL/min/1.73m²; mild RI when GFR = 30-59 mL/min/1.73m²; severe RI when GFR < 29 mL/min/1.73m² and GFR = glomerular filtration ratio.
= oral dose, = intravenous dose

ISSN: 1477-9560