Reviewer ’s report  
 
Title: Clinical impact of the perioperative management of oral a nticoagulants in bleeding after 
colonic endoscopic mucosal resection  
 
Version: 0 Date: 11 Aug 2019  
 
Reviewer: Jessica Yu  
 
Reviewer's report:  
 
The authors have addresse d some of my previous comments however the manuscript still 
requires clarification particularly in the methods and results section. The main merit of the study 
is the ability to compare the outcomes of patients on continuous warfarin, HBT and one -day skip 
DOACs; however, these results are buried in the study as it is currently presented.  
 
1) The article needs significant editing for grammar and English fluency.  
 
2) The methods section remains nebulous.  For example - definition of the control group 
should b e explicit in the text - were those patients on anything (antiplatelets?). 
Additionally, the authors do not specify which groups are being compared in their 
univariate and covariate analysis explicitly (for example, that anticoagulants were 
combined togeth er).  
 
3). How was the warfarin withdraw group analyzed - was this with the anticoagulant cohort 
or control cohort? Again this should be explicit in the text.  
 
4) Tables 1 and 2 present descriptive statistics of two cohorts - bleed vs. non -bleed however, 
it would be more useful to compare the descriptive statistics of the groups: control, HBT, 
continuous warfarin and one -day skip DOAC, similar to what is presented in the first 5 
rows of table 3 as these are the cohorts being compared. They should then pres ent their 
univariate and multivariate analysis separately with bleed as the main outcome. As GIB is 
the only outcome, this could be easily presented graphically with odds ratios w/ 95% CI 
on the X -axis and independent variables/covariates on the y -axis. 
 
5) The strength of this paper is in the fact that the authors are able to capture actual 
anticoagulant use (ie continuous warfarin vs. HBT vs. 1 -day doac cessation vs control), 
this results currently seem buried. The paper would be significantly strengthened  if the 
univariate and multi -variate analysis were conducted using these cohorts as opposed to a 
combined anti -coagulant cohort. If this cannot be done, they should be discussed both as 
a limitation and in their methods.  Currently, the multivariate analys is as presented is 
redundant and confusing and may be simplified by just presenting the GIB rates of 
continuous warfarin/HBT/1day doac cession vs control.  
 
6) The authors conclude that 1 -day DOAC skip would be clinically acceptable in patients as 
peri-opera tive management of patients not on HBT however this conclusion seems to be 
an over -reach as they do not have any patients who went from continuous warfarin to 1 -
day skip DOAC especially as the authors themselves describe this study as a pilot study 
and it is not clear if patients were switched off warfarin to 1 -day stop DOAC therapy. 
The conclusion should be rewritten with this in account.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments t o the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in  your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in  your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complet e a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
publication of this  manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying  for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is y es to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publicat ion, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/ 4.0/). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Clinical impact of the perioperative management of oral a nticoagulants in bleeding after 
colonic endoscopic mucosal resection  
 
Version: 0 Date: 11 Aug 2019  
 
Reviewer: Jessica Yu  
 
Reviewer's report:  
 
The authors have addresse d some of my previous comments however the manuscript still 
requires clarification particularly in the methods and results section. The main merit of the study 
is the ability to compare the outcomes of patients on continuous warfarin, HBT and one -day skip 
DOACs; however, these results are buried in the study as it is currently presented.  
 
1) The article needs significant editing for grammar and English fluency.  
 
2) The methods section remains nebulous.  For example - definition of the control group 
should b e explicit in the text - were those patients on anything (antiplatelets?). 
Additionally, the authors do not specify which groups are being compared in their 
univariate and covariate analysis explicitly (for example, that anticoagulants were 
combined togeth er).  
 
3). How was the warfarin withdraw group analyzed - was this with the anticoagulant cohort 
or control cohort? Again this should be explicit in the text.  
 
4) Tables 1 and 2 present descriptive statistics of two cohorts - bleed vs. non -bleed however, 
it would be more useful to compare the descriptive statistics of the groups: control, HBT, 
continuous warfarin and one -day skip DOAC, similar to what is presented in the first 5 
rows of table 3 as these are the cohorts being compared. They should then pres ent their 
univariate and multivariate analysis separately with bleed as the main outcome. As GIB is 
the only outcome, this could be easily presented graphically with odds ratios w/ 95% CI 
on the X -axis and independent variables/covariates on the y -axis. 
 
5) The strength of this paper is in the fact that the authors are able to capture actual 
anticoagulant use (ie continuous warfarin vs. HBT vs. 1 -day doac cessation vs control), 
this results currently seem buried. The paper would be significantly strengthened  if the 
univariate and multi -variate analysis were conducted using these cohorts as opposed to a 
combined anti -coagulant cohort. If this cannot be done, they should be discussed both as 
a limitation and in their methods.  Currently, the multivariate analys is as presented is 
redundant and confusing and may be simplified by just presenting the GIB rates of 
continuous warfarin/HBT/1day doac cession vs control.  
 
6) The authors conclude that 1 -day DOAC skip would be clinically acceptable in patients as 
peri-opera tive management of patients not on HBT however this conclusion seems to be 
an over -reach as they do not have any patients who went from continuous warfarin to 1 -
day skip DOAC especially as the authors themselves describe this study as a pilot study 
and it is not clear if patients were switched off warfarin to 1 -day stop DOAC therapy. 
The conclusion should be rewritten with this in account.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments t o the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in  your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in  your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complet e a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
publication of this  manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying  for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is y es to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publicat ion, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/ 4.0/). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Clinical impact of the perioperative management of oral a nticoagulants in bleeding after 
colonic endoscopic mucosal resection  
 
Version: 0 Date: 11 Aug 2019  
 
Reviewer: Jessica Yu  
 
Reviewer's report:  
 
The authors have addresse d some of my previous comments however the manuscript still 
requires clarification particularly in the methods and results section. The main merit of the study 
is the ability to compare the outcomes of patients on continuous warfarin, HBT and one -day skip 
DOACs; however, these results are buried in the study as it is currently presented.  
 
1) The article needs significant editing for grammar and English fluency.  
 
2) The methods section remains nebulous.  For example - definition of the control group 
should b e explicit in the text - were those patients on anything (antiplatelets?). 
Additionally, the authors do not specify which groups are being compared in their 
univariate and covariate analysis explicitly (for example, that anticoagulants were 
combined togeth er).  
 
3). How was the warfarin withdraw group analyzed - was this with the anticoagulant cohort 
or control cohort? Again this should be explicit in the text.  
 
4) Tables 1 and 2 present descriptive statistics of two cohorts - bleed vs. non -bleed however, 
it would be more useful to compare the descriptive statistics of the groups: control, HBT, 
continuous warfarin and one -day skip DOAC, similar to what is presented in the first 5 
rows of table 3 as these are the cohorts being compared. They should then pres ent their 
univariate and multivariate analysis separately with bleed as the main outcome. As GIB is 
the only outcome, this could be easily presented graphically with odds ratios w/ 95% CI 
on the X -axis and independent variables/covariates on the y -axis. 
 
5) The strength of this paper is in the fact that the authors are able to capture actual 
anticoagulant use (ie continuous warfarin vs. HBT vs. 1 -day doac cessation vs control), 
this results currently seem buried. The paper would be significantly strengthened  if the 
univariate and multi -variate analysis were conducted using these cohorts as opposed to a 
combined anti -coagulant cohort. If this cannot be done, they should be discussed both as 
a limitation and in their methods.  Currently, the multivariate analys is as presented is 
redundant and confusing and may be simplified by just presenting the GIB rates of 
continuous warfarin/HBT/1day doac cession vs control.  
 
6) The authors conclude that 1 -day DOAC skip would be clinically acceptable in patients as 
peri-opera tive management of patients not on HBT however this conclusion seems to be 
an over -reach as they do not have any patients who went from continuous warfarin to 1 -
day skip DOAC especially as the authors themselves describe this study as a pilot study 
and it is not clear if patients were switched off warfarin to 1 -day stop DOAC therapy. 
The conclusion should be rewritten with this in account.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments t o the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in  your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in  your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complet e a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
publication of this  manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying  for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is y es to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publicat ion, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/ 4.0/). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant