We congratulate Frimat et al1 for their case series of renal cortical necrosis in women with severe postpartum hemorrhage. As described by the authors, all women received tranexamic acid (TXA), and duration of TXA administration was the only factor associated with a poor kidney outcome at 6 months.1 Although we acknowledge the balanced conclusions of the authors, we believe that this new piece of evidence questions the relevance of some guidelines in which the use of TXA for postpartum hemorrhage treatment now appears to have been overenthusiastically encouraged, with no clear recommendations for maximal dose and duration2 and despite the lack of robust evidence. The rationale for these recommendations is based on: (1) an extrapolation from randomized controlled trials conducted in other clinical contexts3 and (2) results of EXADELI, an open-label randomized controlled trial in women with postpartum hemorrhage4 but with methodological limitations.