Comparison of bleeding and tubal rupture rates after use of tranaxamic acid with methotrexate in treatment of ectopic pregnancy

Abstract

Ectopic pregnancy is the implantation of a fertilized ovum in a location other than the endometrial cavity. The most commonly used medical treatment for ectopic pregnancy is the folic acid antagonist methotrexate (MTX). Bleeding and tubal rupture may occur after tubal damage caused by MTX. Tranexamic acid is an antifibrinolytic agent frequently used in elective surgical procedures. In our study, we aimed to investigate whether the use of tranexamic acid together with MTX in ectopic pregnancy would reduce bleeding and tubal rupture rates. In our study, 137 patients who were diagnosed with ectopic pregnancy and treated with MTX between January 2020 and January 2023 in our clinic were evaluated retrospectively. Tranexamic acid was applied to 36 of the cases on the first day of MTX treatment. Tubal rupture occurred in 14 (13.9%) out of 101 patients who received only MTX and in 13 (36.1%) out of 36 patients who received MTX+tranexamic acid. There was a statistically significant difference between the MTX only group and the MTX+tranexamic acid group in terms of tubal rupture status. Tubal rupture was observed to be statistically significantly higher in the MTX+tranexamic acid group. Prospective studies with larger case series are required to confirm the safety of using tranexamic acid together with MTX in the treatment of ectopic pregnancy.

Keywords

• Ectopic pregnancy
• methotrexate
• tranexamic acid
• bleeding

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