Reviewer’s report
Title: 
Acute portal vein thrombosis secondary to COVID-19: a case report
Version: 
0 
Date: 
10 Aug 2020
Reviewer's report:
Interesting clinical case. However some criticisms may be raised and should be
addressed. Please, follow the list below for more details:
1.Please, specify if they started intravenous heparin or low-molecular-weight
heparin (LMWH). All the anticoagulant doses should be presented adjusted for
the body weight. Therefore authors should also add 
the body weight of the
patient.
2.How was the Hb drop during the acute 
bleeding? Did the patient need packed
red blood cell transfusion? How was the mean arterial pressure drop? How were
lactates? In other words did the patient develop a hemodynamic shocK? 
If this is
the case, this information would enhance the importance of seeking for this
thrombotic complication during Sars-Cov-2 infection.
3.How was managed the gastro-intestinal bleeding? Did the patient receive
terlipressin or other vasocative drug? This would be in line with the
interpretation of teh episode as consequence of portal hypertension due to the
portal vein thrombosis. 
4.Could authors add the mean corpuscolar volume and ferritin to the blood
analysis presented in the table? This would be useful for differential diagnosis of
anemia. How do authors explain the Hb drop before the episode of the acute
bleeding? Did authors think about any ectopic gastro-intestinal varice as
bleeding source in this case? 
5.What about anticoagulation after discharge of the patient? Do authors have any
follow up data? It would be important checking if the prompt start of
anticoagulation was efficacious to avoid the evolution to cavernoma of the portal
vein 
6.The interpretation of platelet-count drop as thrombotic thrombocytopenic
purpura is quite hazardous. Did authors test the patient for adamts-13 activity in
line with this hypothesis? Did they exclude disseminated intravascular
coagulation as consequence of the acute respiratory failure? Was there an
overlap with any bacterial infection which could be associated with platelet drop
during acute infection? Did authors ruled out/considered heparin induced
thrombocytopenia? 
7.Authors should provide the references of the clinical case mentioned in the
discussion as the first reported on portal vein thrombosis during covid. Along
this line they should also update the reference list. There is at least one other
report already published on the same topic (V. 
La Mura et al AJG 2020).
Minor comments.
Some typos: PH instead of pH; vital sign instead of vital signs. Was creatinine
level 17 mg% and BUN 1mg% on the 21st of April or is it symply 
a typos?
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No
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 this manuscript, 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 have no competing interests
Reviewer 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 manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. 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)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Acute portal vein thrombosis secondary to COVID-19: a case report
Version: 
0 
Date: 
10 Aug 2020
Reviewer's report:
Interesting clinical case. However some criticisms may be raised and should be
addressed. Please, follow the list below for more details:
1.Please, specify if they started intravenous heparin or low-molecular-weight
heparin (LMWH). All the anticoagulant doses should be presented adjusted for
the body weight. Therefore authors should also add 
the body weight of the
patient.
2.How was the Hb drop during the acute 
bleeding? Did the patient need packed
red blood cell transfusion? How was the mean arterial pressure drop? How were
lactates? In other words did the patient develop a hemodynamic shocK? 
If this is
the case, this information would enhance the importance of seeking for this
thrombotic complication during Sars-Cov-2 infection.
3.How was managed the gastro-intestinal bleeding? Did the patient receive
terlipressin or other vasocative drug? This would be in line with the
interpretation of teh episode as consequence of portal hypertension due to the
portal vein thrombosis. 
4.Could authors add the mean corpuscolar volume and ferritin to the blood
analysis presented in the table? This would be useful for differential diagnosis of
anemia. How do authors explain the Hb drop before the episode of the acute
bleeding? Did authors think about any ectopic gastro-intestinal varice as
bleeding source in this case? 
5.What about anticoagulation after discharge of the patient? Do authors have any
follow up data? It would be important checking if the prompt start of
anticoagulation was efficacious to avoid the evolution to cavernoma of the portal
vein 
6.The interpretation of platelet-count drop as thrombotic thrombocytopenic
purpura is quite hazardous. Did authors test the patient for adamts-13 activity in
line with this hypothesis? Did they exclude disseminated intravascular
coagulation as consequence of the acute respiratory failure? Was there an
overlap with any bacterial infection which could be associated with platelet drop
during acute infection? Did authors ruled out/considered heparin induced
thrombocytopenia? 
7.Authors should provide the references of the clinical case mentioned in the
discussion as the first reported on portal vein thrombosis during covid. Along
this line they should also update the reference list. There is at least one other
report already published on the same topic (V. 
La Mura et al AJG 2020).
Minor comments.
Some typos: PH instead of pH; vital sign instead of vital signs. Was creatinine
level 17 mg% and BUN 1mg% on the 21st of April or is it symply 
a typos?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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 this manuscript, 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 have no competing interests
Reviewer 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 manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. 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)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Acute portal vein thrombosis secondary to COVID-19: a case report
Version: 
0 
Date: 
10 Aug 2020
Reviewer's report:
Interesting clinical case. However some criticisms may be raised and should be
addressed. Please, follow the list below for more details:
1.Please, specify if they started intravenous heparin or low-molecular-weight
heparin (LMWH). All the anticoagulant doses should be presented adjusted for
the body weight. Therefore authors should also add 
the body weight of the
patient.
2.How was the Hb drop during the acute 
bleeding? Did the patient need packed
red blood cell transfusion? How was the mean arterial pressure drop? How were
lactates? In other words did the patient develop a hemodynamic shocK? 
If this is
the case, this information would enhance the importance of seeking for this
thrombotic complication during Sars-Cov-2 infection.
3.How was managed the gastro-intestinal bleeding? Did the patient receive
terlipressin or other vasocative drug? This would be in line with the
interpretation of teh episode as consequence of portal hypertension due to the
portal vein thrombosis. 
4.Could authors add the mean corpuscolar volume and ferritin to the blood
analysis presented in the table? This would be useful for differential diagnosis of
anemia. How do authors explain the Hb drop before the episode of the acute
bleeding? Did authors think about any ectopic gastro-intestinal varice as
bleeding source in this case? 
5.What about anticoagulation after discharge of the patient? Do authors have any
follow up data? It would be important checking if the prompt start of
anticoagulation was efficacious to avoid the evolution to cavernoma of the portal
vein 
6.The interpretation of platelet-count drop as thrombotic thrombocytopenic
purpura is quite hazardous. Did authors test the patient for adamts-13 activity in
line with this hypothesis? Did they exclude disseminated intravascular
coagulation as consequence of the acute respiratory failure? Was there an
overlap with any bacterial infection which could be associated with platelet drop
during acute infection? Did authors ruled out/considered heparin induced
thrombocytopenia? 
7.Authors should provide the references of the clinical case mentioned in the
discussion as the first reported on portal vein thrombosis during covid. Along
this line they should also update the reference list. There is at least one other
report already published on the same topic (V. 
La Mura et al AJG 2020).
Minor comments.
Some typos: PH instead of pH; vital sign instead of vital signs. Was creatinine
level 17 mg% and BUN 1mg% on the 21st of April or is it symply 
a typos?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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 this manuscript, 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 have no competing interests
Reviewer 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 manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. 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)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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