- 1. NAME OF THE MEDICINAL PRODUCT
- 2. QUALITATIVE AND QUANTITATIVE COMPOSITION
- 3. PHARMACEUTICAL FORM
- 4. CLINICAL PARTICULARS
- 4.1 Therapeutic indications
- 4.2 Posology and method of administration
- 4.3 Contraindications
- 4.4 Special warnings and precautions for use
- 4.5 Interactions with other medicinal products and other forms of interactions
- 4.6 Pregnancy and lactation
- 4.7 Effects on ability to drive and use machines
- 4.8 Undesirable effects
- 4.9 Overdose
- 5. PHARMACOLOGICAL PROPERTIES
1.NAME OF THE MEDICINAL PRODUCT
TachoSil sealant matrix
2.QUALITATIVE AND QUANTITATIVE COMPOSITION
TachoSil contains per cm2:
For a full list of excipients, see section 6.1.
TachoSil is an
TachoSil is indicated in adults for supportive treatment in surgery for improvement of haemostasis, to promote tissue sealing, for suture support in vascular surgery where standard techniques are insufficient, and for supportive sealing of the dura mater to prevent postoperative cerebrospinal leakage following neurological surgery (see section 5.1).
4.2Posology and method of administration
The use of TachoSil is restricted to experienced surgeons.
The quantity of TachoSil to be applied should always be oriented towards the underlying clinical need for the patient. The quantity of TachoSil to be applied is governed by the size of the wound area.
Application of TachoSil must be individualised by the treating surgeon. In clinical trials, the individual dosages have typically ranged from
(4.8 cm x 4.8 cm or 3.0 cm x 2.5 cm) or the
Method and route of administration
For epilesional use only. Do not use intravascularly.
See section 6.6 for more detailed instructions.
TachoSil is not recommended for use in children below age 18 years due to insufficient data on safety and efficacy.
TachoSil must not be applied intravascularly.
Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.
4.4Special warnings and precautions for use
For epilesional use only.
Do not use intravascularly. Life threatening thromboembolic complications may occur if the preparation is applied intravascularly.
Specific data have not been obtained on the use of this product in gastrointestinal anastomoses surgery.
It is not known whether recent radiation therapy affects the efficacy of Tachosil when used for dura mater sealing.
As with any
To prevent the development of tissue adhesions at undesired sites, ensure tissue areas outside the desired application area are adequately cleansed before administration of TachoSil (see section 6.6). Events of adhesions to gastrointestinal tissues leading to gastrointestinal obstruction have been reported with use in abdominal surgery carried out in proximity to the bowel.
In case of shock, the current medical standards for shock treatment should be observed.
Standard measures to prevent infections resulting from the use of medicinal products prepared from human blood or plasma include selection of donors, screening of individual donations and plasma pools for specific markers of infection and the inclusion of effective manufacturing steps for the inactivation/removal of viruses. Despite this, when medicinal products prepared from human blood or plasma are administered, the possibility of transmitting infective agents cannot be totally excluded. This also applies to unknown or emerging viruses and other pathogens.
The measures taken are considered effective for enveloped viruses such as HIV, HBV and HCV and for the
It is strongly recommended that every time TachoSil is administered to a patient, the name and batch number of the product are recorded in order to maintain a link between the patient and the batch of the product.
4.5Interactions with other medicinal products and other forms of interactions
No formal interaction studies have been performed.
Similar to comparable products or thrombin solutions, the sealant may be denatured after exposure to solutions containing alcohol, iodine or heavy metals (e.g. antiseptic solutions). Such substances should be removed to the greatest possible extent before applying the sealant.
4.6Pregnancy and lactation
The safety of TachoSil for use in human pregnancy or breastfeeding has not been established in controlled clinical trials. Experimental animal studies are insufficient to assess the safety with respect to reproduction, development of the embryo or foetus, the course of gestation and peri- and postnatal development.
Therefore, TachoSil should be administered to pregnant and breastfeeding women only if clearly needed.
4.7Effects on ability to drive and use machines
Hypersensitivity or allergic reactions (which may include angioedema, burning and stinging at the application site, bronchospasm, chills, flushing, generalised urticaria, headache, hives, hypotension, lethargy, nausea, restlessness, tachycardia, tightness of the chest, tingling, vomiting, wheezing) may occur in rare cases in patients treated with fibrin sealants/haemostatics. In isolated cases, these reactions may progress to severe anaphylaxis. Such reactions may especially be seen, if the preparation is applied repeatedly, or administered to patients known to be hypersensitive to constituents of the product.
Antibodies against components of fibrin sealant/haemostatic products may occur rarely.
However, in a clinical trial with TachoSil in hepatic surgery, in which patients were investigated for the development of antibodies, 26% of the 96 patients tested and treated with TachoSil developed antibodies to equine collagen. The equine collagen antibodies that developed in some patients after TachoSil use were not reactive with human collagen. One patient developed antibodies to human fibrinogen.
There were no adverse events attributable to the development of human fibrinogen or equine collagen antibodies.
There is very limited clinical data available regarding
Thromboembolic complications may occur if the preparation is applied intravascularly (see section 4.4).
For viral safety see section 4.4
Summary of the safety profile
The safety data of TachoSil generally reflect the type of
Data from the eight controlled clinical trials conducted by the MAH has been pooled into an integrated dataset. In the integrated analyses, 997 patients were treated with TachoSil and 984 patients were treated with comparator treatment. Due to practical reasons (comparison to standard surgical and standard haemostatic treatment), blinding was not possible in the TachoSil trials. Therefore the studies were performed as
Tabulated summary of adverse reactions
The following adverse reactions have been reported with TachoSil during post marketing experience. The frequency of all of the events listed below has been categorised as not known (cannot be estimated from the available data).
System organ class
Frequency not known
Immune system disorders
Anaphylactic shock, Hypersensitivity
Intestinal obstruction (in abdominal surgeries)
General disorders and administration site
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.
No case of overdose has been reported.
TachoSil contains fibrinogen and thrombin as a dried coating on the surface of a collagen matrix. In contact with physiological fluids, e.g. blood, lymph or physiological saline solution the components of the coating dissolve and partly diffuse into the wound surface. This is followed by the fibrinogen- thrombin reaction which initiates the last phase of physiological blood coagulation. Fibrinogen is converted into fibrin monomers which spontaneously polymerise to a fibrin clot, which holds the collagen matrix tightly to the wound surface. The fibrin is then cross linked by endogenous factor XIII, creating a firm, mechanically stable network with good adhesive properties and therefore provides sealing as well.
Clinical studies demonstrating haemostasis were conducted in a total of 240 patients (119 TachoSil, 121 argon beamer) undergoing partial liver resection surgery and 185 patients (92 TachoSil,
93 standard surgical treatment) undergoing surgical resection of superficial renal tumour. A further controlled study in 119 patients (62 TachoSil, 57 haemostatic fleece) demonstrated sealing, haemostasis and suture support in patients undergoing cardiovascular surgery. Tissue sealing in lung surgery was investigated in two controlled trials in patients undergoing lung surgery. The first controlled clinical trial investigating tissue sealing in lung surgery failed to document superiority over standard treatment measured by air leakage due to the inclusion of a large group of patients (53%) without air leakage. However, the second study investigating tissue sealing in 299 patients
(149 TachoSil, 150 standard surgical treatment) with demonstrated intraoperative air leakage showed the superiority of TachoSil compared to standard treatment.
The efficacy of TachoSil was tested in a randomised controlled study in 726 patients (362 treated with TachoSil and 364 controls) undergoing skull base surgery as an adjunct to suture for sealing the dura mater, in which the efficacy outcome was measured
current practise practice (which included suture, duraplasty and fibrin and polymer sealants or combinations of these) could not be documented. The numbers of subjects experiencing an efficacy outcome event were 25 (6.9%) and 30 (8.2%) for TachoSil and current practice treated patients, respectively, providing an Odds Ratio of 0.82 (95% CI: 0.47, 1.43). However, the 95% confidence intervals for the odds ratio results indicated that TachoSil had similar efficacy to current practice. In this study two application techniques for TachoSil were evaluated: application of TachoSil over the dura and application of TachoSil on both sides of the dura. The results did not support the second method. TachoSil was found to be well tolerated and safe for use as an adjunct to dura mater closure in neurosurgery.
TachoSil is intended for epilesional use only. Intravascular administration is contraindicated. As a consequence, intravascular pharmacokinetic studies were not performed in man.
Fibrin sealants/haemostatics are metabolized in the same way as endogenous fibrin by fibrinolysis and phagocytosis.
In animal studies, TachoSil biodegrades after administration to a wound surface with few remnants left after 13 weeks. Complete degradation of TachoSil was seen in some animals 12 months after its administration to a liver wound, whereas small remnants were still observed in others. The degradation was associated with infiltration of granulocytes and formation of resorptive granulation tissue encapsulating the degraded remnants of TachoSil. No evidence of local intolerability has been observed in animal studies.
From the experience in humans there have been isolated cases where remnants were observed as coincidental findings with no signs of functional impairment
5.3Preclinical safety data
Single dose toxicity studies in different species of animals have shown no signs of acute toxic effects.
6 PHARMACEUTICAL PARTICULARS
6.1List of excipients
Equine collagen Human albumin Riboflavine (E101) Sodium chloride Sodium citrate (E331)
Once the foil sachet is opened, TachoSil must be used immediately.
6.4Special precautions for storage
Do not store above 25 C.
6.5Nature and contents of container
Each sealant matrix is packed in a
Package with 1 matrix of 9.5 cm x 4.8 cm
Package with 2 matrices of 4.8 cm x 4.8 cm
Package with 1 matrix of 3.0 cm x 2.5 cm
Package with 5 matrices of 3.0 cm x 2.5 cm
Package with 1
Not all pack sizes may be marketed.
6.6Special precautions for disposal and other handling
TachoSil comes ready to use in sterile packages and must be handled accordingly. Use only undamaged packages. Once the package is opened,
TachoSil is used under sterile conditions. Prior to application the wound area should be cleansed, e.g. from blood, disinfectants and other fluids. After removal of the conventional, flat TachoSil from the sterile package it should be
After removal of the
Pressure is applied with moistened gloves or a moist pad. Due to the strong affinity of collagen to blood, TachoSil may also stick to surgical instruments, gloves or adjacent tissues covered with blood. This can be avoided by cleansing surgical instruments, and gloves and adjacent tissues before application. It is important to note that failure to adequately clean adjacent tissues may cause adhesions (see section 4.4). After pressing TachoSil to the wound, the glove or the pad must be removed carefully. To avoid TachoSil from being pulled loose it may be held in place at one end, e.g. with a pair of forceps.
Alternatively, e.g. in case of stronger bleeding, TachoSil may be applied without
The active side of TachoSil should be applied so that it extends
In neurosurgery, TachoSil should be applied on top of the primary dura closure.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
7 MARKETING AUTHORISATION HOLDER
Takeda Austria GmbH
St. Peter Strasse 25
8 MARKETING AUTHORISATION NUMBER
9 DATE OF FIRST AUTHORISATION / RENEWAL OF THE AUTHORISATION
Date of first authorisation: 8 June 2004
Date of latest renewal: 8 June 2009
10 DATE OF REVISION OF THE TEXT
Detailed information on this medicinal product is available on the website of the European Medicines Agency (EMA) http://www.ema.europa.eu/