Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 07 May 2020
Reviewer's report:
The authors compare conventional coagulation tests (CCTs) versus point of care testing (ROTEM)
in 55 compensated cirrhotic patients and 22 patients with ACLF.
Major points
1.Utility of ROTEM in non ACLF (compensated cirrhosis) patientsIt is established clinical practice not to correct platelets or INR based on CCTs in compensatedcirrhotic patients. Various components of ROTEM like maximum clot firmness, A10 min, αangle,
lysis etc. would be normal in most such patients. What would be the indication to do ROTEM inthis set of patients?
2.Timing of ROTEM in ACLF patients
Expectedly patients with ACLF are sicker and have significantly higher infections, organ failureand mortality. Their state of 'balanced coagulation' is altered with more bleeding episodes.ROTEM therefore shows corresponding abnormalities. Since ACLF is a dynamic state withrapidly changing clinical condition, ROTEM would give a snapshot of the current coagulationstate. When do the authors recommend doing ROTEM in ACLF patients? At what time point/swas it done in this study? In patients with bleeding was ROTEM done after the bleeding episode todecide which components to correct? Are the authors suggesting that ROTEM indices (MCF or
A10) can be used to predict a bleed in ALCF and preemptive correction given?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 yes to any, please give details below.
I declare that I do not have any conflict of interestsReviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report.
(default)
Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 07 May 2020
Reviewer's report:
The authors compare conventional coagulation tests (CCTs) versus point of care testing (ROTEM)
in 55 compensated cirrhotic patients and 22 patients with ACLF.
Major points
1.Utility of ROTEM in non ACLF (compensated cirrhosis) patientsIt is established clinical practice not to correct platelets or INR based on CCTs in compensatedcirrhotic patients. Various components of ROTEM like maximum clot firmness, A10 min, αangle,
lysis etc. would be normal in most such patients. What would be the indication to do ROTEM inthis set of patients?
2.Timing of ROTEM in ACLF patients
Expectedly patients with ACLF are sicker and have significantly higher infections, organ failureand mortality. Their state of 'balanced coagulation' is altered with more bleeding episodes.ROTEM therefore shows corresponding abnormalities. Since ACLF is a dynamic state withrapidly changing clinical condition, ROTEM would give a snapshot of the current coagulationstate. When do the authors recommend doing ROTEM in ACLF patients? At what time point/swas it done in this study? In patients with bleeding was ROTEM done after the bleeding episode todecide which components to correct? Are the authors suggesting that ROTEM indices (MCF or
A10) can be used to predict a bleed in ALCF and preemptive correction given?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 yes to any, please give details below.
I declare that I do not have any conflict of interestsReviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report.
(default)
Please review this paper.
user
Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 0Date: 07 May 2020
Reviewer's report:
The authors compare conventional coagulation tests (CCTs) versus point of care testing (ROTEM)
in 55 compensated cirrhotic patients and 22 patients with ACLF.
Major points
1.Utility of ROTEM in non ACLF (compensated cirrhosis) patientsIt is established clinical practice not to correct platelets or INR based on CCTs in compensatedcirrhotic patients. Various components of ROTEM like maximum clot firmness, A10 min, αangle,
lysis etc. would be normal in most such patients. What would be the indication to do ROTEM inthis set of patients?
2.Timing of ROTEM in ACLF patients
Expectedly patients with ACLF are sicker and have significantly higher infections, organ failureand mortality. Their state of 'balanced coagulation' is altered with more bleeding episodes.ROTEM therefore shows corresponding abnormalities. Since ACLF is a dynamic state withrapidly changing clinical condition, ROTEM would give a snapshot of the current coagulationstate. When do the authors recommend doing ROTEM in ACLF patients? At what time point/swas it done in this study? In patients with bleeding was ROTEM done after the bleeding episode todecide which components to correct? Are the authors suggesting that ROTEM indices (MCF or
A10) can be used to predict a bleed in ALCF and preemptive correction given?
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 yes to any, please give details below.
I declare that I do not have any conflict of interestsReviewer Publication Consent. 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) if this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. If you change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report.
(default)
assistant