Review for 10.1186/s12876-020-01413-w (2020)

Reviewer’ s report
Title: Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to
conventional coagulation test in ACLF and Non-ACLF patients
Version: 1Date: 21 Jul 2020
Reviewer's report:
Thank you for addressing previous comments and making changes to the manuscript.
1. If I understand correctly you are suggesting doing a ROTEM prior to any intervention in
compensated cirrhosis patients to guide transfusion. This may reduce transfusion of blood/products as compared to CCTs.
2. In all patients ROTEM was done within 24 hours of admission. In the 9 patients with ACLF
who bled, were the significantly lower A10 and MCF apparent at this time? How much time afteradmission did these patients bleed and was transfusion guided by ROTEM at the time of bleeding.Addressing these questions might give a clue about the utility of these ROTEM parameters inpredicting a bleed and also give some pointers about a protocol for timing of these point of caretesting in sick (ACLF) patients.
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