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Comparison of Subcuticular Suture Type for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial.

the Kruithof study4 analyzed the blood samples of only 10 women. We also are aware of this and included a second reference with more than 70 women with postpartum hemorrhage, demonstrating a significant increase in D-dimer levels,5 which was overlooked by the authors. More data and well-designed studies to improve our understanding of the role of TXA in obstetric hemorrhage are always welcome. We encourage all investigators, including the authors of the letter, to perform these studies or report on their experience with TXA. However, we feel that withholding TXA from patients who are experiencing severe hemorrhage despite first-line agents would be irresponsible at this time.