The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad
, Genís Campreciós 1,2,3,†, Valeria Pérez-Campuzano 1,2, Lara Orts 1,2,3, Joan Carles García-Pagán 1,2,3,4 and Virginia Hernández-Gea 1,2,3,4,*
Round 1
Reviewer 1 Report
This is a very nicely written review on the pathophysiology of PVT in patients with cirrhosis. The paper is well balanced and provides interesting data and discussion. Some points of clarification/minor issues:
1) In their introduction, the Authors indicated that PVT has a negative impact on liver transplantation. They may want to include some specific references here.
2) I am not sure that the ratio between FVIII and PC is used to evaluate the coagulation status in the general population.
3) I would consider the inclusion of specific comments regarding patients with NASH. There are recent data (see for example: 10.1055/s-0038-1676954; 10.1111/tri.13895) suggesting that, perhaps particularly in these patients, the pathophysiology of PVT requires further investigation.
4) I appreciate the explore new hypothesis (i.e. thrombus composition) and investigate new potential treatments (i.e. endothelium etc). However, I would make clear that the first line treatment of PVT (whenever “indicated”) is still based on anticoagulation. The conclusion that PVT is not a thrombus but “rather a stenosis” may be somewhat too hasty.
Author Response
Please see the attachment
Author Response File: 
Author Response.docx
Reviewer 2 Report
This review summarizes the latest studies on PVT and discusses the future direction of PVT in cirrhosis. The graphic abstract well summarizes the progression of PVT in different cirrhotic stages.
However, there is a lack of systemic evidence evaluation in the review, such as the effect size, the grade of the evidence, and the bias of the included studies. For example, in lines 223-235, the author made an objective evaluation of the previous studies. It would be better to include the effect size, like the OR, RR of the studies.
In the intravascular vessel wall (endothelial) damage part, how did the author differentiate the endothelial damage and the hypercoagulation state?
Author Response
Please see the attachment.
Author Response File: Author Response.docx
