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

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

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]
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)
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)
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]
PERI 3.75 mg/kg/h continuous infusion
Low bleeding risk + mild RI PRE 10-15 mg/kg
PERI 2.50 mg/kg/h continuous infusion
Low bleeding risk + severe RI PRE 10-15 mg/kg
PERI 1.25 mg/kg/h continuous infusion
High bleeding risk + minor RI PRE 25-30 mg/kg
PERI 11-16 mg/kg/h continuous infusion
High bleeding risk + mild RI PRE 25-30 mg/kg
PERI 5-10 mg/kg/h continuous infusion
High bleeding risk + severe RI PRE 25-30 mg/kg
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
  1. 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.
  2. = oral dose, = intravenous dose