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Research Projects Funded in 2009

Non-steroidal anti-inflammatory drugs and menorrhagia revisited

Dr. Rochelle Winikoff, FRCP
Staff hematologist
CHU Sainte-Justine - Montreal, Quebec
Second year funding (2008 funding and work deferred into 2009 because of delay in ethics approval)

Co-investigators: Dr. Sylvain Chemtob, Dr. Michèle David, Dr. Diane Francoeur, Dr. Georges-Étienne Rivard

Heavy menstrual bleeding (menorrhagia) is an important health care problem. It is a common condition that results in considerable morbidity and cost to society. Non-steroidal anti-inflammatory drugs (NSAIDS) can successfully decrease menstrual blood flow in women with menorrhagia. They work largely by blocking the production of prostaglandins which are chemical substances responsible for controlling blood flow in the uterus. NSAIDS are not widely used for this purpose mainly because the response is often modest and or unpredictible. The variable response to NSAIDS among women with menorrhagia is not well understood. Our goal is to optimize therapy for menorrhagia by identifying a subgroup of women that is most likely to respond well to NSAIDS and to establish a clear place for NSAIDS in the treatment of menorrhagia. We hypothesize that a subset of women with menorrhagia related to high levels of prostacyclin (a substance that causes dilation of blood vessels) will have a superior response to NSAID therapy than those without. The presence of other prostaglandin related menstrual symptoms may also be important clinical predictors of response to NSAIDS in women with menorrhgia. In this study adult women with menorrhagia will be treated with an NSAID for two consecutive menstrual periods and their clinical response assessed. Potential clinical predictors of response to NSAID treatment will be collected  including baseline prostaglandin urinary measures. Clinical predictors of response to NSAID treatment will be then be determined. The results of this study should help clinicians identify women for whom NSAID therapy should be considered upfront to treat menorrhagia. Clinical indices including baseline prostacyclin measurements could be a part of the initial clinical evaluation for menorrhagia and could help distinguish between women with menorrhagia who are likely to respond to treatment with NSAIDS and those who are not, in whom alternative therapies may be more beneficial. A similar treatment strategy could eventually be applied to women with menorrhagia related to bleeding disorders.  

Development of a clinical history assessment tool for bleeding disorders

Dr. Catherine Hayward
McMaster University and Hamilton Health Sciences
Dept. of Pathology and Molecular Medicine
McMaster University Medical Center – Hamilton, Ontario
First year funding

Co-Investigators: Dr. Menaka Pai, Ms. Nancy Heddle, Dr. Richard Cook.

Bleeding problems are common in the general population, but they can be challenging to assess. This is because healthy people can experience some types of bleeding (e.g. mild bruises and nosebleeds) and because abnormal bleeding is sometimes mild in severity. To assess patients with possible bleeding problems, doctors traditionally ask many questions about excessive bleeding. Patients often find it difficult to answer so many questions during an appointment, and doctors are unsure which questions are most important. A brief, standardized questionnaire would be helpful to ensure that patients are asked important questions, using language that is easy to understand.

Our research group has collected a large amount of information on the symptoms and laboratory findings for over 300 patients with bleeding problems. We propose to use statistical methods to analyze this information and develop a brief questionnaire. We will give this questionnaire to a large group of patients and healthy people to fill out, to explore what symptoms are common in patients with the most common types of bleeding disorders (undefined bleeding disorders and platelet secretion defects), and what their risks of bleeding are. I am optimistic that the questionnaire will help doctors decide which patients have blood clotting problems, and need to have further investigations done. It will also help us learn more about the most common types of bleeding disorders, and how they can impact patients' lives. This research has potential to improve patient care, by generating evidence on the best way to assess bleeding symptoms, how they manifest in different types of bleeding disorders, and how to optimize treatment of bleeding.

Understanding Health and Treatment Decision-Making Among Young People with Hemophilia: A Youth Perspective

Dr. Kathryn Webert
Department of Medicine
McMaster University – Hamilton, Ontario
First year funding

Co-Investigators:  Prof. Nancy Heddle, Dr. Anthony Chan, Dr. Irwin Walker, Ms. Shannon Lane.

The first generation of young people with hemophilia to have grown up using primary prophylaxis are ‘coming of age’ and making the transition from childhood to adolescence and early adulthood.  At this point, they may decide to continue with prophylaxis or switch to on-demand therapy. There is no clear evidence suggesting that either one of these treatments is superior in adulthood and nothing is known about how young people make the decision about which treatment to use as they mature.  We know that patient decision-making about medical treatment involves considering the scientific evidence, but it is also influenced by patients’ attitudes, life experiences, feelings about their disease, values and beliefs.  This research is concerned with understanding these non-medical aspects of decision-making around hemophilia treatments. To find out what the main factors are in their decision-making, we will conduct interviews and a focus group with 15 – 29-year old patients with hemophilia in Southern Ontario, followed by 3 focus groups of similar patients from across Canada. The results of this research will help us to understand how young people with hemophilia make decisions about their treatment, and will be used to develop strategies for discussing treatment choices with this age group.

The Assessment of the Minimal Effective and Tolerated Dose of Tranexamic Acid in Women with Menorrhagia who have Bleeding Disorders

Dr. Katherine Sue Robinson
Dept. of Medicine, Division of Adult
QEII Health Sciences Center – Halifax, Nova Scotia
Co Principal Investigator:
Dr. Victoria Price
IWK Health Center- Halifax, Nova Scotia
First year funding

Co-Investigators: Dr. Tamara Macdonald, Prof. Mohamed Abdolell, Dr. Eileen Mcbride, Dr. Nancy Van Eyk, Dr. Joan Wenning.

Many women have heavy periods and this can be associated with low blood, tiredness and inability to carry out normal activities.  Approximately 10-30 % of these women will have an underlying bleeding disorder. There is a drug called tranexamic acid which is commonly used and is effective in reducing menstrual flow. However, up to 1/3 of women have side affects and they are more common at higher doses.  In the medical literature, there are different dosing schedules and there is one commonly recommended in Canada.   Women with underlying bleeding disorders may require higher doses of this medication compared to those who do not. In our study, we want to find the lowest effective dose of tranexamic acid for girls and women with heavy periods who have bleeding disorders and we think this will be lower then the usual recommended dose. If our results support this, it may contribute to changing how we presently prescribe this medication and may provide a better option for women with heavy periods in particular those with bleeding disorders. We have just started a Women with Bleeding Disorders Clinic and hope that this project will lead to better care for our patients and more research in the future.