Cerebral Venous Sinus Thrombosis Associated with Vaccine-Induced Thrombotic Thrombocytopenia—A Narrative Review
, Johanna A. Kremer Hovinga 2, Marcel Arnold 1 and Mirjam R. Heldner 1,*Round 1
Reviewer 1 Report
authors perform a review on VITT but i found several missing point:
-references should be updated
-type of thromboses occurring after a vaccine should be updated if also thromboses without increase of antiPFA Ab are considered
-hystorical occurrence of thrombosis after vaccination is not considered in the tex and it is a relevant topic also for other type of vaccines
although in a minority of cases VITT occur also after other type of antiSARS CoV2 vaccines
- these are only the most relevant missing point of the manuscript that i consider but all in relevant part of the manuscript
Author Response
We thank the reviewer for the time and consideration in revising our manuscript.
- References should be updated.
Many thanks for this important point, since the scope of the review is to inform on latest we looked at the presently available evidence on VITT and found no significant new aspects on the disease. We added two more references, which add relevant content (Ref 58, 59).
- Hystorical occurrence of thrombosis after vaccination is not considered in the text and it is a relevant topic also for other type of vaccines.
We thank the reviewer for this relevant observation. We added in manuscript information on this in the epidemiology section.
- Although in a minority of cases VITT occur also after other type of antiSARS CoV2 vaccines
This is an important observation. We are aware of thrombosis with thrombocytopenia cases after mRNA-based SARS-CoV-2 vaccines. We are, however, not aware of any case of thrombosis with thrombocytopenia and positive anti-PF4 antibodies after mRNA-based vaccines. We explain this aspect in the ‘Pathophysiological aspects’ of the manuscript.
Reviewer 2 Report
- Please re-write first para in introduction. Sentence/phrases are not good.
- Poor sentence construction, for eg, The authors proposed a heparin-induced thrombocytopenia (HIT) mimicry as pathomechanism, since all VITT patients tested positive for anti-platelet factor (PF) 4/heparin antibodies and for platelet activation assays despite no recent heparin exposure.
- Do not start the sentence with prepositions and pronouns.
- Greinacher et al. year is missing
- Lot of syntax errors/Typo errors in the entire manuscript. Manuscript is poorly written. The concept of VITT is vaguely described.
- IVIG concept is poorly fetched
- Prognosis section is poorly described
- No figure numbers
- incomplete tables
Author Response
We thank the reviewer for the time and effort they took to review our manuscript.
- Please re-write first para in introduction. Sentence/phrases are not good.
We thank the reviewer for pointing this out. We made stylistic changes, which we hope have improved this paragraph now.
- Poor sentence construction, for eg, The authors proposed a heparin-induced thrombocytopenia (HIT) mimicry as pathomechanism, since all VITT patients tested positive for anti-platelet factor (PF) 4/heparin antibodies and for platelet activation assays despite no recent heparin exposure.
We thank the reviewer for pointing this out. We rephrased the sentence.
- Do not start the sentence with prepositions and pronouns.
We thank the reviewer for this remark. We have adapted some sentences accordingly.
- Greinacher et al. year is missing
Many thanks. We added the year of publication of the cited paper by Greinacher et al. 2021 in the revised manuscript.
- Lot of syntax errors/Typo errors in the entire manuscript. Manuscript is poorly written. We thank the reviewer for pointing this out. We re-read the manuscript text and identified some typos, which are now corrected.
- The concept of VITT is vaguely described.
We thank the reviewer for this feedback. We agree, that the concept of VITT is vaguely described. However, our aim was to enlighten the most important aspects of VITT known to date. We are fully aware of the fact, that the concept is subject to discussions and future minor specifications and changes.
We state in the introduction section, that ‘VITT has been first well described by Greinacher A et al. in March 2021. He published a case series (n=11) on patients with thrombosis and thrombocytopenia which occurred 5-16 days after administration of the adenovirus-based SARS-CoV-2 vaccine ChAdOx1 nCoV-1 (AstraZeneca/Oxford)’.
- IVIG concept is poorly fetched
We thank the reviewer for pointing this out. We agree, that we have included little information on the IVIG concept in this piece of work. However, we did not aim for a detailed insight into therapy recommendations, which are constantly evolving still.
- Prognosis section is poorly described
We thank the reviewer for pointing this out. We now tried to add some more information in this section.
- No figure numbers
We have now added figure numbers.
- incomplete tables
We thank the reviewer for pointing this out. We added ‘n/a’ in the empty fields of the tables.
Round 2
Reviewer 1 Report
Improvements have been Made but a clear re organization of manuscript is needed.
in participarono there is a problem with references in the text that are not sequential at this Moment
Author Response
We thank the reviewers for the time and effort they took to review our manuscript.
Answers to Reviewer 1
- Improvements have been Made but a clear re organization of manuscript is needed, in participarono there is a problem with references in the text that are not sequential at this Moment,
Answer: Many thanks to the reviewer for having spotted the non-consecutive numbering of references. We have tried to further improve our English.
Reviewer 2 Report
All the comments were addressed satisfactorily. English check required
Author Response
We thank the reviewers for the time and effort they took to review our manuscript.
Answer to Reviewer 2
- All the comments were addressed satisfactorily. English check required.
Answer: We thank the reviewer for his comment. We have tried to further improve our English.
