Comparative effectiveness of epsilon-aminocaproic acid and tranexamic acid on postoperative bleeding following cardiac surgery during a national medication shortage

Study objective: The aim of this study was to compare the effectiveness of epsilon-aminocaproic acid (epsilon ACA) and tranexamic acid (TXA) in contemporary clinical practice during a national medication shortage. Design: A retrospective cohort study. Setting: The study was performed in all consecutive cardiac surgery patients (n = 128) admitted to the cardiac-surgical intensive care unit after surgery at a single academic center immediately before and during a national medication shortage. Measurements: Demographic, clinical, and outcomes data were compared by descriptive statistics using X-2 and t test. Surgical drainage and transfusions were compared by multivariate linear regression for patients receiving epsilon ACA before the shortage and TXA during the shortage. Main results: In multivariate analysis, no statistical difference was found for surgical drain output (OR 1.10, CI 0.97-1.26, P = .460) or red blood cell transfusion requirement (OR 1.79, CI 0.79-2.73, P = .176). Patients receiving epsilon ACA were more likely to receive rescue hemostatic medications (OR 1.62, CI 1.02-2.55, P = .041). Conclusions: Substitution of sACA with TXA during a national medication shortage produced equivalent postoperative bleeding and red cell transfusions, although patients receiving sACA were more likely to require supplemental hemostatic agents. Published by Elsevier Inc.