Management of Antithrombotic Therapy in Acute Gastrointestinal Bleeding

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This review is presented as a literature review but the majority of the references are to existing guidelines or reviews. It is however a good summary of the principles and recommendations of the major existing guidelines. The special populations is a useful addition to existing work. The advice would be clearer to the reader with additional tables or algorithms. 

 

Author Response

-This review is presented as a literature review but the majority of the references are to existing guidelines or reviews. It is however a good summary of the principles and recommendations of the major existing guidelines. The special populations is a useful addition to existing work. The advice would be clearer to the reader with additional tables or algorithms.

 

-Answer: Thank you for taking the time to review our manuscript. We have added an algorithm (Figure 1) to guide clinicians through management of antithrombotic agents in urgent GI bleeding.

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript: “Management of Antithrombotic Therapy in Urgent GI Endoscopy” presents knowledge on antithrombotic issues in urgent GI endoscopy, especially bleeding.

I have detected some flaws:

1. The topic has been previously well described also in the guidelines .
2. The methods are not well described: what was the period of time for the selection of the articles, how many were selected etc. Not to mention that implementing the PRISMA guidelines would be most appropriable. Although authors mentioned that in study limitation section I believe that the manuscript would gain a lot being systematic.

I would reconsider the article after major revisions.

Author Response

• The topic has been previously well described also in the guidelines.

Answer 1: Although this topic has been previously described in the guidelines referenced in the text, the management of antithrombotic agents during urgent GI endoscopy remains a challenge for clinicians. By reviewing recent evidence and adding information regarding special populations, we tried to provide useful guidance for clinicians in the management of antithrombotics in this severe condition.

 

• The methods are not well described: what was the period of time for the selection of the articles, how many were selected etc. Not to mention that implementing the PRISMA guidelines would be most appropriable. Although authors mentioned that in study limitation section I believe that the manuscript would gain a lot being systematic.

Answer 2: Thank you for your comment. We have added additional information in the methods section to answer questions such the period of time for article selection and how many articles were selected (written in red). Our review was not systematic in nature and that is why the PRISMA guidelines were not implemented. Although the methods used in our search were not systematic, we believe we provide important guidance for clinicians in everyday practice and suggestions for further future research.

Reviewer 3 Report

Comments and Suggestions for Authors

The author comprehensively reviewed the English literatures about antithrombotic therapy in Urgent GI Endoscopy

The authors proposed that current guidelines provide useful guidance and recommendations in clinical practice. However, authors point out the lower quality evidence of some recommendations due to base on expert opinions. Besides, some evidence was based on retrospective studies instead of randomized controlled trials.

Besides, I have some concerns

1. Methodology: The author did not detail description of how many articles included into systemic review, the including criteria. How many articles were excluded, excluding criteria? Study flow chart was suggested.
2. Besides, the authors should mention which part of urgent endoscopy belongs to lower evidence. And which part had high quality of evidence.
3. The evidence classification is usually shown in review articles.

Author Response

• Methodology: The author did not detail description of how many articles included into systemic review, the including criteria. How many articles were excluded, excluding criteria? Study flow chart was suggested.

Answer 1: Thank you for your comment. We have added additional information in the methods section to answer questions such the period of time for article selection and how many articles were selected (written in red). Our review was not systematic in nature and that is why a flow chart not implemented. Although the methods used in our search were not systematic, we believe we provide important guidance for clinicians in everyday practice and suggestions for further future research.

• Besides, the authors should mention which part of urgent endoscopy belongs to lower evidence. And which part had high quality of evidence.

Answer 2: Thank you for your comment. Our review was not systematic in nature, and therefore a complete assessment of evidence was not done. While a formal grading of evidence is not directly applicable to this review, the recommendations provided are based on the best available evidence and expert consensus on the field.

• The evidence classification is usually shown in review articles.

Answer 3: Same as Answer 2.