Comparative effectiveness of Amicar & TXA on postop bleeding after cardiac surgery

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

Blaine KP, et al. J Clin Anesth. 2016.

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Abstract

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 χ(2) 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.

Published by Elsevier Inc.

PMID

 27871586 [PubMed - in process]

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