From the Guidelines
Tranexamic acid dosage should be adjusted in patients with impaired renal function to prevent accumulation and potential adverse effects. The adjustment of Tranexamic Acid (TXA) dose in patients with kidney disease is crucial due to its primary elimination through the kidneys. According to the study published in Anaesthesia in 2010 1, repeat doses of TXA should be used with caution in patients with renal impairment. Although the study does not provide specific dose adjustment guidelines, it highlights the importance of cautious use in patients with renal impairment. In clinical practice, the dose of TXA is often adjusted based on the patient's creatinine clearance (CrCl). Some general guidelines for dose adjustment include:
- For patients with mild renal impairment (CrCl 50-80 mL/min), no dose adjustment is typically needed.
- For moderate impairment (CrCl 30-50 mL/min), the dose may be reduced to 50% of the standard dose.
- In severe impairment (CrCl 15-30 mL/min), the dose may be reduced to 25% of the standard dose.
- For end-stage renal disease (CrCl <15 mL/min), alternative hemostatic agents or significantly reduced doses may be considered. It is essential to regularly monitor renal function and adjust the TXA dose accordingly to minimize the risk of adverse effects, such as seizures and thrombotic complications, as the drug accumulates in patients with impaired renal function 1.
From the FDA Drug Label
Reduce the dosage for patients with renal impairment. (2.2,8.6) The blood levels of tranexamic acid are increased in patients with renal insufficiency. Therefore, dose adjustment is needed in patients with renal impairment [see Dosage and Administration (2.2), Use in Specific Populations (8. 6)].
The dose of Tranexamic Acid (TXA) should be adjusted in patients with impaired renal function.
- Dose reduction is necessary for patients with renal impairment.
- The exact dose adjustment is not specified in the provided drug labels, but it is recommended to adjust the dose based on the degree of renal impairment. 2 2
From the Research
Dose Adjustment of Tranexamic Acid in Kidney Disease
- The dose of Tranexamic Acid (TXA) should be adjusted in patients with impaired renal function to avoid accumulation and potential toxicity 3, 4, 5, 6, 7.
- Studies have shown that TXA is renally cleared and may accumulate in patients with chronic kidney disease (CKD), leading to elevated plasma concentrations and increased risk of adverse events such as seizures and thromboembolic events 3, 4, 5, 6.
- A pharmacokinetic study found that plasma TXA concentrations were higher in patients with poor renal function and clearance compared to those with good renal function, and recommended a new dosing regimen to optimize the anti-fibrinolytic effect of TXA and avoid excessive dosing 3.
- Another study proposed a simple new TXA dosing regimen that optimizes maximal antifibrinolysis and avoids excessive drug dosing in patients with CKD undergoing cardiac surgery 4.
- Simulations have shown that adjustment of the maintenance infusion rate based on the percent reduction in renal clearance can result in predicted plasma TXA concentrations that are safe and therapeutic 5.
- Clinical manifestations of TXA toxicity in CKD patients include neurotoxicity, thrombotic complications, and other adverse events, highlighting the importance of dosage adjustment in these patients 6.
- Dosage recommendations for TXA therapy in cases of renal failure have been investigated, and it is essential to adjust the dose according to renal function to avoid accumulation and potential toxicity 7.
Recommended Dosing Regimens
- A bolus infusion of 15 mg/kg over 15 min together with a maintenance infusion of 7.5 mg/kg/h or 5 mg/kg/h for 2 hours for patients with good and poor renal function, respectively 3.
- A new dosing regimen that optimizes maximal antifibrinolysis and avoids excessive drug dosing in patients with CKD undergoing cardiac surgery 4.
- Adjustment of the maintenance infusion rate based on the percent reduction in renal clearance to result in predicted plasma TXA concentrations that are safe and therapeutic 5.