The authors must be commended for conducting this randomized controlled study on the efficacy of tranexamic acid (TA) for the control of postpartum hemorrhage (PPH). It is, however, unfortunate that this was an open-label study, with the inherent possibility of introducing biases in the interpretation of the results. Adverse events were more frequent in the TA group, maybe because the loading dose was somewhat high. Pharmacokinetic studies have shown that 30 mg/kg of TA result in maximal antifibrinolytic effect; subsequent studies should consider lower doses of TA (see Dowd NP et al, Anesthesiology 2002;97:390-9). Nevertheless, this is an important study that will modify our clinical practice.

– Jean-François Hardy