Hemodynamics, fluids & transfusion
Tranexamic Dosing for Major Joint Arthroplasty in Adult Patients with Chronic Kidney Disease: A Pharmacokinetic Study and New Dosing Regimen
Authors' conclusion
Population pharmacokinetic modeling and simulation resulted in recommendations for a new dosing regimen to optimize the antifibrinolytic effect of tranexamic acid and avoid excessive dosing.
Study context
- Population
- Adults undergoing hip or knee replacement surgery, June 2020 to September 2022
- Participants
- 21 adults
- Exposure
- Good vs poor renal function after IV TXA 20-mg/kg bolus
- Outcome
- Plasma TXA concentration levels (serial blood samples) after IV TXA 20-mg/kg bolus after anesthesia induction
Methodological detailspopulation pharmacokinetic modeling and simulation
- Population pharmacokinetic modeling and simulation
Main finding
As reported in the abstract
Plasma TXA concentration
- Plasma TXA levels higher with poor renal function and clearance vs good renal function
- Simulations: single-bolus TXA leads to rapid rise and decline in plasma concentrations
- Plasma TXA 50 to 75 mg/l maintained for ≈4 h with 15 mg/kg bolus over 15 min plus maintenance infusion for 2 h of 7.5 (good) or 5 (poor renal function) mg · kg −1 · h −1
Observational data: associations, not effects.
Secondary outcomes
Red cell transfusion, mortality, LOS
- No difference in secondary outcomes
Safety
Adverse events (thromboembolic events, seizures)
- No difference in secondary outcomes
Original publication
Tranexamic Dosing for Major Joint Arthroplasty in Adult Patients with Chronic Kidney Disease: A Pharmacokinetic Study and New Dosing Regimen. Anesthesiology. Published 29 January 2025. doi:10.
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