Title: Risk Factors and Management of Gastrointestinal Bleeding in Patients With or Without
Antiplatelet and Anticoagulation therapy: a Multicenter Real-world Prospective Study
Version: 1 Date: 21 Dec 2023
Reviewer's report:
This study is a more detailed study of the association between GIB patients who received
antiplatelet or anticoagulant medications before ED admission for GIB and all-cause mortality,
and factors contributing to the treatment of GIB, with a larger sample of approximately 2300
GIB patients than previous studies.
However, there are some issues regarding the methods, which are described below to improve
this study.
Major points:
1. The number of variables in the multivariate logistic regression of the main analysis is too
large relative to the number of events, so overfitting is likely. Even if the number of variables
could be reduced, multicollinearity would need to be checked.
2. What about reducing the number of variables by summarizing them? For example, what about
using the HAS-BLED score to assess a patient's risk of bleeding?
3. I would suggest that you provide more detail on the definitions of the diseases and drugs
used as variables, such as ICD10 codes or WHO-ATC classifications so that the study can be
replicated using this paper as a reference. Also, for variables selected as variables for multivariate
logistic regression, please describe their clinical significance and previous studies that provide
the evidence.
4. Were patients grouped according to whether or not they were prescribed antiplatelet or
anticoagulant medications within six weeks before GIB events? How were patients treated if
they were taking both antiplatelet and anticoagulant medications during the period? Also, if they
were on a combination drug but most recently on a single drug, were they grouped by the drugs
most recently administered? Please describe, as this was not mentioned.
5. What about using the length of ED stay as a variable to indicate the severity of GIB? Also,
how about evaluating by cause-specific hazard ratios for all-cause death events since discharge
from the ED, rather than by odds ratios for the 28-day mortality rate since ED admission?
6. Please describe the sample size design as described in the STROBE statement.
Minor points:
Methods:
7. Please describe any reasons for setting medications within six weeks before GIB events.
Results:
8. If less than 10%, the value should be rounded to the first decimal place. If more than 10%,
the value should be rounded to the integer value.
9. If the P value is greater than 0.01, the P value should be rounded to the second significant
digit. If the P value is less than 0.01, the P value should be rounded to the first significant digit,
such as P = 0.007.
10. The number of excluded patients in Figure 1 was not stated, so please describe it.
Title: Risk Factors and Management of Gastrointestinal Bleeding in Patients With or Without
Antiplatelet and Anticoagulation therapy: a Multicenter Real-world Prospective Study
Version: 1 Date: 21 Dec 2023
Reviewer's report:
This study is a more detailed study of the association between GIB patients who received
antiplatelet or anticoagulant medications before ED admission for GIB and all-cause mortality,
and factors contributing to the treatment of GIB, with a larger sample of approximately 2300
GIB patients than previous studies.
However, there are some issues regarding the methods, which are described below to improve
this study.
Major points:
1. The number of variables in the multivariate logistic regression of the main analysis is too
large relative to the number of events, so overfitting is likely. Even if the number of variables
could be reduced, multicollinearity would need to be checked.
2. What about reducing the number of variables by summarizing them? For example, what about
using the HAS-BLED score to assess a patient's risk of bleeding?
3. I would suggest that you provide more detail on the definitions of the diseases and drugs
used as variables, such as ICD10 codes or WHO-ATC classifications so that the study can be
replicated using this paper as a reference. Also, for variables selected as variables for multivariate
logistic regression, please describe their clinical significance and previous studies that provide
the evidence.
4. Were patients grouped according to whether or not they were prescribed antiplatelet or
anticoagulant medications within six weeks before GIB events? How were patients treated if
they were taking both antiplatelet and anticoagulant medications during the period? Also, if they
were on a combination drug but most recently on a single drug, were they grouped by the drugs
most recently administered? Please describe, as this was not mentioned.
5. What about using the length of ED stay as a variable to indicate the severity of GIB? Also,
how about evaluating by cause-specific hazard ratios for all-cause death events since discharge
from the ED, rather than by odds ratios for the 28-day mortality rate since ED admission?
6. Please describe the sample size design as described in the STROBE statement.
Minor points:
Methods:
7. Please describe any reasons for setting medications within six weeks before GIB events.
Results:
8. If less than 10%, the value should be rounded to the first decimal place. If more than 10%,
the value should be rounded to the integer value.
9. If the P value is greater than 0.01, the P value should be rounded to the second significant
digit. If the P value is less than 0.01, the P value should be rounded to the first significant digit,
such as P = 0.007.
10. The number of excluded patients in Figure 1 was not stated, so please describe it.
Please review this paper.
user
Title: Risk Factors and Management of Gastrointestinal Bleeding in Patients With or Without
Antiplatelet and Anticoagulation therapy: a Multicenter Real-world Prospective Study
Version: 1 Date: 21 Dec 2023
Reviewer's report:
This study is a more detailed study of the association between GIB patients who received
antiplatelet or anticoagulant medications before ED admission for GIB and all-cause mortality,
and factors contributing to the treatment of GIB, with a larger sample of approximately 2300
GIB patients than previous studies.
However, there are some issues regarding the methods, which are described below to improve
this study.
Major points:
1. The number of variables in the multivariate logistic regression of the main analysis is too
large relative to the number of events, so overfitting is likely. Even if the number of variables
could be reduced, multicollinearity would need to be checked.
2. What about reducing the number of variables by summarizing them? For example, what about
using the HAS-BLED score to assess a patient's risk of bleeding?
3. I would suggest that you provide more detail on the definitions of the diseases and drugs
used as variables, such as ICD10 codes or WHO-ATC classifications so that the study can be
replicated using this paper as a reference. Also, for variables selected as variables for multivariate
logistic regression, please describe their clinical significance and previous studies that provide
the evidence.
4. Were patients grouped according to whether or not they were prescribed antiplatelet or
anticoagulant medications within six weeks before GIB events? How were patients treated if
they were taking both antiplatelet and anticoagulant medications during the period? Also, if they
were on a combination drug but most recently on a single drug, were they grouped by the drugs
most recently administered? Please describe, as this was not mentioned.
5. What about using the length of ED stay as a variable to indicate the severity of GIB? Also,
how about evaluating by cause-specific hazard ratios for all-cause death events since discharge
from the ED, rather than by odds ratios for the 28-day mortality rate since ED admission?
6. Please describe the sample size design as described in the STROBE statement.
Minor points:
Methods:
7. Please describe any reasons for setting medications within six weeks before GIB events.
Results:
8. If less than 10%, the value should be rounded to the first decimal place. If more than 10%,
the value should be rounded to the integer value.
9. If the P value is greater than 0.01, the P value should be rounded to the second significant
digit. If the P value is less than 0.01, the P value should be rounded to the first significant digit,
such as P = 0.007.
10. The number of excluded patients in Figure 1 was not stated, so please describe it.
assistant