Factors Determining Ticagrelor-Induced Dyspnea in Patients with Acute Coronary Syndrome
Round 1
Reviewer 1 Report
In this study, the authors demonstrated that a lower ADP HS value possibly indicated greater ticagrelor activity and higher plasma 29 concentration of this drug. Atorvastatin might have an impact on the occurrence of ticagrelor-related dyspnea by affecting ticagrelor metabolism. No impact of any genetic variant on the development of dyspnea was determined.
Minor concerns:
1. English languages in the whole text need to be improved.
2. Whether some related commodities such as hypertension, diabetes, smoking, et al are associated with the incidence of dyspnea?
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
I congratulate the authors for such a nice, well-designed study.
Author Response
We would like to thank Reviewer2 for his/her time and efforts put into reviewing our manuscript.
Reviewer 3 Report
I read the manusript Factors determining ticagrelor dyspnea in patients with acute coronary syndrome with great interest.
I find the reported results of research extremely important in the discussion reagrding the causes of dyspnea after ticagrelor administration. Nevertheless, the manuscript itself seems far too long to me. The Authors unnecessarily present the results of genotypes assessment for which no effect on the pharmacokinetics and pharmacodynamics of ticagrelor has been previously proven. In particular, it concerns genotypes of enzymes responsible for clopidogrel metabolism. On the other hand, the results of pharmacokinetic assessments, which are pivotal for the interpretation of pharmacodynamics are missing. According to the study flow chart (Figure 2), blood samples for pharmacokinetic assessment were taken 24-36 hours after admission. In addition to the strengths of this manuscript, highlighted by the Authors, it also has its limitations that should be mentioned.
Author Response
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Author Response File: Author Response.docx
Round 2
Reviewer 3 Report
Accepting the Authors' arguments in response to the review, I still disagree with the conclusions of the manuscript.
The research found a greater level of platelet inhibition in patients with dyspnea, wich is not the same as the greater activity of ticagrelor. Moreover speculation regarding pharmacokinetics is unfounded without demonstrating the relevant results.
Author Response
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Author Response File: Author Response.docx
