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 (εACA) 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 χ² and t test. Surgical drainage and transfusions were compared by multivariate linear regression for patients receiving εACA 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 εACA were more likely to receive rescue hemostatic medications (OR 1.62, CI 1.02–2.55, P = .041). Conclusions Substitution of εACA with TXA during a national medication shortage produced equivalent postoperative bleeding and red cell transfusions, although patients receiving εACA were more likely to require supplemental hemostatic agents.