Review for 10.1186/s12876-022-02611-4 (2022)

Reviewer’s report
Title: 
Survival Outcomes of Patients with Concomitant Acute Variceal Bleeding
and Acute Coronary Syndrome, and the role of antiplatelet agents; An
Institutional Experience from a Lower Middle-Income Country.
Version: 
0 
Date: 
12 Sep 2022
Reviewer: 
Bulent Baran
Reviewer's report:
Dear authors,
In this study entitled "Survival Outcomes of Patients with Concomitant Acute
Variceal Bleeding and Acute Coronary Syndrome, and the role of antiplatelet
agents; An Institutional Experience from a Lower Middle-Income Country" the
investigators did a retrospective cohort study including 29 patients admitted with
concomitant acute variceal bleeding and acute coronary syndrome from January
2002 to December 2017. The authors reported the mortality rate and its
statistically significant association with severity of underlying liver disease.
They emphasized that there was no significant difference in the incidence of
recurrent AVB and ACS regardless of anti-platelet therapy. However only 7
patients received antiplatelet therapy. Besides, patients who did not receive
antiplatelet therapy had not experienced any ACS during the follow-up (0/15),
however patients who received antiplatelet therapy had 2 cases with ACS among
7 patients (p=0.091). How do the authors explain this trend for higher ACS rate
in patients treated with antiplatelet therapy? 
The authors stated that "Concomitant AVB and ACS is a severe disorder with
increased mortality among patients at presentation, however, recurrence is low
following acute insult". In this statement, the authors are providing a comparison
such as "recurrence is low". I recommend including a control group of AVB
patients without ACS which presented to the hospital during the same study
period for a more evidence-based comparison. What is the usual rate of recurrent
AVB in this hospital setting when there is no concomitant ACS or antiplatelet
use?
There is need for a flowchart that shows how many patients were admitted with
AVB during the study period and how many patients were excluded at what
basis? 
How many patients had STEMI, NSTEMI or unstable angina?
Hypothesis of the study is not clearly defined in the introduction or methods
section. Please revise. 
What is new in this study? What did we know about the problem and what is the
new insight this study has provided?
Definition of ACS should be more specific. Please revise. 
Your sincerely
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Is the study design appropriate to answer the research question (including the use
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presented?
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