A Retrospective Longitudinal Study on Venous Thromboembolisms: The Impact of Active Monitoring on the Venous Thromboembolism Management Practices of Healthcare Providers to Improve Patient Outcomes

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Because VTE is associated with substantial morbidity and mortality when untreated, accurate risk assessment and appropriate prophylaxis programs are vital, as overlooked risk factors of these processes can potentially result in misdiagnosis and inappropriate treatment of the condition, with associated complications. Therefore, the Authors performed the longitudinal retrospective study with the aim to assess the impact of active monitoring on VTE management practices among healthcare providers towards patient outcomes.

The results of this study indicate that active monitoring through continuous education and regular patient rounds, significantly improves adherence to VTE risk assessment and prophylaxis at IAFH. The researchers attributed the increased identification and timely reporting of VTE cases to vigilance by healthcare providers and not to a decline in care quality. A comprehensive, multidisciplinary strategy to VTE management and continuous quality improvement can help reduce VTE-related morbidity and improve patient outcomes. Lastly, addressing risk factors involved in the occurrence of hospital-acquired VTE and post-discharge follow-up of patients were recommended.

 

The manuscript is written on seventeen pages, four of which contain references. It includes two tables and two figures.

The text is written in the standard English language with the use of sophisticated statistical methods and Professional approach in this point of view.

Statistical Process Control (SPC) was used to analyze and interpret the data, combining time series analysis with a graphical presentation of data.

Content suggestions:

1. I would like to kindly ask the Authors to provide details about adverse effects of the antithrombotic drugs used by the included patients.
2. Can the Authors provide the details about further drugs influencing hemostasis ?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Rateb Abd Alrazak Daowd et al. in their article "Venous Thromboembolism Retrospective Longitudinal Study: “The Impact of Active Monitoring on VTE Management Practices of Healthcare Providers’ Towards Patient Outcomes” conduct a retrospective study to assess the impact of active monitoring on VTE management practices among healthcare providers towards patient outcomes.
I thank the authors for their contribution, but I have noted several critical issues and concerns.
The abstract needs to be rewritten. The purpose of the abstract is to briefly provide the reader with information about the article. In this case, the abstract is too long and contains unnecessary information.
The introduction is not well structured. The introduction should provide the background of the study. In this case, small studies are cited that transform the introduction into a discussion. The background of TEP and VTE should be provided, risk factors should be analyzed (all and not cited randomly), no works should be cited, but information from guidelines should be provided and the purpose of the review should be provided.
The materials and methods are sufficiently represented. It would be useful to use a table for inclusion and exclusion criteria.
The discussion presents significant critical issues. Were the images taken by the authors? The quality is also poor.
The discussion lacks many citations. The discussion describes small and insignificant studies.
The conclusions do not meet the purpose of the review.

Comments on the Quality of English Language  

English difficult to understand with many grammatical errors. English editing needed

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This research is a longitudinal retrospective study design to identify patients at risk of VTE and PE in term of risks, prevention and outcomes.

Minor remarks

Some abbreviations are not clarified or are introduced too early: line 31, IAFH is not clarified, but once explained, it can be reused throughout the text. On line 96, CBAHI is not clarified as well. From the context, one understands that it is a sort of equivalent to JCI. On line 148, same remark applies to OVRs."

Other remarks:

- It is surprising regarding the variety and heterogeneity of disciplines (medical, surgical, and gynecological/obstetrics) that the number of VTE is so low. Particularly because your timeline covers the COVID period (usually about 15-20% in severe COVID patients according to the literature) Do you have an explanation for this 

A table with the patients' cohort characteristics and distribution in the hospitals wards would be useful

- The study spans six years. Have your risk assessment tools and your prevention and treatment practices remained unchanged throughout this period? Or have they evolved with the introduction of new anticoagulants (e.g., in orthopedics) and the issuance of new guidelines from international societies?

• Table 1: patients distribution is  18-40:7, 41-60:2, 61-74:0,75 more:2
• Table 2: patients distribution is   18-40:3,41-60:4, 61-74:0;75 more:
  • are the patients different between the two tables?

In table 2: The prophylaxis used varies in terms of the product (LMWH or heparin) and the dosage employed. In the case of guidelines, efforts are made to clarify towards a more standardized regimen. Could you provide clarification? Additionally, Figures 1 and 2 are not legible within the text; it would be better to submit them on a separate sheet, as they might be clearer in that format and clarify the question.

Graph 1: On the x-axis, is it the number of events? Please clarify this in the legend

Graph 2: The total number of patients should be indicated under each year (2018 n=..., 2019 n=...). Indeed, OVRs change over time, but we have no idea if the detected percentage remains the same, which could suggest that your detection methods evolve over the years

Graph 3: Why does the orange line drop in 2022, even though the percentage remains high (99%)?"

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I would like to thank the Authors for the resubmission of the manuscript. Currently, the revised version became clearer and I am satisfied with all changes that the Authors made - they did what they could to improve their manuscript. I do not have any further objections and I sincerely appreciate each new information about life-threatening venous thromboembolism. 

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, I don't think there have been the necessary improvements requested.

Reviewer 3 Report

Comments and Suggestions for Authors

responses to remarks are adequate