title: Comparative effectiveness of epsilon-aminocaproic acid and tranexamic acid on postoperative bleeding following cardiac surgery during a national medication shortage.
abstract: 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.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  Demographic, clinical, and outcomes data were compared by descriptive statistics using χ2and t test. Surgical drainage and transfusions were compared by multivariate linear regression for patients receiving εACA before the shortage and TXA during the shortage.
  
  
  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.
authors.affiliation: Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University Medical Center, 300 Pasteur Dr, H3580, Stanford, CA 97305. Electronic address: kevin.blaine@nih.gov.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Blaine
authors.affiliation: Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University Medical Center, 300 Pasteur Dr, H3580, Stanford, CA 97305.
authors.forename: Christopher
authors.initials: C
authors.lastname: Press
authors.affiliation: Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University Medical Center, 300 Pasteur Dr, H3580, Stanford, CA 97305.
authors.forename: Ken
authors.initials: K
authors.lastname: Lau
authors.affiliation: Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University Medical Center, 300 Pasteur Dr, H3580, Stanford, CA 97305.
authors.forename: Jan
authors.initials: J
authors.lastname: Sliwa
authors.affiliation: Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University Medical Center, 300 Pasteur Dr, H3580, Stanford, CA 97305.
authors.forename: Vidya K
authors.initials: VK
authors.lastname: Rao
authors.affiliation: Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University Medical Center, 300 Pasteur Dr, H3580, Stanford, CA 97305.
authors.forename: Charles
authors.initials: C
authors.lastname: Hill
mesh_terms: D015119:Aminocaproic Acid / Q000494:pharmacology* / Q000600:supply & distribution*; D000933:Antifibrinolytic Agents / Q000494:pharmacology / Q000600:supply & distribution; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D057186:Comparative Effectiveness Research / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000188:drug therapy*; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D015119:Aminocaproic Acid
keywords: Blood conservation; Cardiac surgery; Perioperative bleeding; Tranexamic acid; ε-aminocaproic acid