Can Transamin be used in patients with DIC?

As a rule, the use of Transamin in patients with DIC is contraindicated. From a practical standpoint, however, it is not rare that secondary fibrinolysis occurs as an excessive response, which worsens bleeding or can even endanger patient’s life. To save patients from the life-threating situation caused by bleeding, there may be no choice but to use an antiplasminic agent.

In this case, Transamin is used until bleeding stops, and administration is discontinued as soon as possible after bleeding has stopped. This will minimize tissue damage in the kidney and other organs resulting from intravascular coagulation.

What is DIC?

DIC stands for disseminated intravascular coagulation syndrome or diffuse intravascular coagulation syndrome. It is a sign of bleeding susequent to unadjustable activation of coagulatio factors and fibrinolytic enzymes in small vessels. When DIC occurs, fibrin deposits, and fibrinogen, prothrombin, coagulation factors (Factors V, VIII, XIII), and platelets are consumed in the process of coagulation. Fibrin degradatin products inhibit polumerization of fibrin, which results in tissue necrosis and bleeding.

Are there any data on percutaneous absorption of Transamin?

The absorbtion of Transamin into normal skin is very slow. It is slightly better for the skin from which the horny layer has been peeled off. Wheen Transamin at a concentratio of 96 mg/ml was applied on guinea pigs to examine its percutaneous absorption, the following results were obtained.

How is Transamin used for patients undergoing cardiac surgery with cardiopulmonary bypass?

Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at high risk for postoperative bleeding. Excessive bleeding after CPB is attributable not only to the size of surgical wound required for the operation but also the activation of both coagulation and fibrinolysis by the passage of blood through the CPB bypass. The stimulation of the formation and dissolution of blood clots causes excessive consumption of coagulant factors and predisposes patients to prolonged and excessive bleeding. The severe bleeding complication increases morbidity and mortality and also the need for transfusion, reoperation and costs.

Nakashima et al. evaluated the effect of Transamin on blood loss after CPB in 157 patients who underwent elective valve replacement operations. Transamin was administered in 90 patients (Group TA) at 50 mg/kg just before and after CPB, and every minute during CPB. Remaining 67 patients serve as the control group (Group N). The time required for hemostasis was significantly shorter in Group TA (6.7 + 1.5 hr vs. 6.0 + 1.5 hr, p – 0.006). The amount of chest tube drainage within 12 hr after surgery was significantly reduced and the chest tube could be removed earlier in Grout TA. The total blood loss was significantly smaller than in Group TA (402 + 292 ml) than in Group N (631 + 609 ml, p = 0.003). It was concluded that antifibrinolytic therapy during CPB with Transamin reduces postoperative loss, and shortens the operation time due to an improvement in hemostasis.

What is the dose of Transamin when used to stop bleeding associated with tonsillectomy in pediatric patients?

One of major problems that arise after tonsillectomy is rebleeding. It is recommended that Transamin be used for adults in the following doses. When it is administered to children, the dose is reduced according to the age, etc.

2 hours before operation :

500 mg, intravenous injection

1 day after operation :

250 mg, every 4 hours

2 to 4 days after operation :

500 mg, 3 times a day, oral administration

How is Transamin used for treatment of gastric bleeding?

Upper Gastrointestinal Bleeding has been observed that gastric mucosa is rich in plasminogen activator and fibrinolytic activity is high in gastric venous blood. Therefore, it seems to be rationale to use fibrinolytic drugs in the management of bleeding from gastrointestinal lesion.

Henry et al. performed a meta-analysis fo six randomized double-blind placebo controlled trials from UK, Sweden and Australia which investigated the effect of fibrinolytic inhibitors in 1,267 patients in total with upper gastrointestinal bleeding. Most patients were bleeding from peptic ulcers in the stomach and duodenum (43 – 88%) or gastric erosions (4 – 23 %). Transamin 3 – 6 g/day given intravenously for 2 or 3 days followed by 3 – 6 g/day orally for a further 3 to 5 days (four trials) or 4.5 – 12 g/day orally for 2 to 7 days (two trials). Treatment with Transamin was associated with a 20 – 30% reduction in the rate of rebleeding, and a 40% reduction (95% confidence interval 10 – 60 %) in mortality. From the meta-analysis, it was concluded that Transamin might be of value to patients considered to be at risk of dying after an upper gastrointestinal hemorrhage.

Except for pulmonary tubercolosis, what kinds of diseases are the targets of Transamin?

Bleeding from lung cancer (most frequently seen), pneumonia, bronchitis, or severe inflammation of upper respiratory tract.

How is Transamin used for treatment of pulmonary tuberculosis?

Sato et al. administered Transamin to 34 patients with pneumonia, bronchial ectasia, or pulmonary tuberculosis who had bloody sputum or hemoptysis, at a minimum maintenance dose of 250 mg, 3 times a day, to investigate the hemostatic effect of Transamin. The dose was increased to 1,500 mg per day when the amount of bloody sputum was large. Administration of Transamin stopped bleeding in 30 patients (88.2%). In 2 patients (5.9%), bleeding was stopped when the drug was administered, but bloody sputum recurred after a while. In the other 2 patients (5,9%), the drug had almost no effect. The drug can be administered without anxiety about adverse reactions. It is administered at a high dose at early stages, and after bleeding has stopped, the dose is reduced gradually until the administration is discontinued. When it is administered as  a preventative treatment from 3 to 4 days before a period in which patients easily have bloody sputum, such as a menstrual period, when a typhoon is approaching, or flu season, it sometimes happens that patients do not have bloody sputum at all.

What is the dose of Transamin when used for treatment of bleeding associated with the removal of prostate gland or ureteral calculus?

2 hours prior to operation :

            500 mg, intravenous injection

1 day after operation :

            250 mg, every 4 hours

2 to 4 days after operation :

            500 mg, oral administration, 3 times a day

What kinds of renal hemorrhages are there?

Renal hemorrhages include idiopathic renal hemorrhage and bleeding accompanying acute/chronic nephritis, renal calculus, or renal tumor.

Kobayashi et.al. investigated the therapeutic effect of Transamin in an open non-comparative clinical trial using 108 patients with acute (n = 5) and chronic (n = 103) nephritis. Transamin was administered orally at 2 g to 36 g daily over a period of 2-6 months. The improvement rates of proteinuria were 34% in patients treated with smaller doses (> 3.1 g) for less than 3 months and 94% in patients treated with larger doses for more than 3 months. The same tendency was also observed in the improvement of erythrocytuira.