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Research Projects Funded in 2018

Canadian Hemophilia Management in the Perinatal Setting (CHiMPS)


Dr. Paul Moorehead
Janeway Children’s Health and Rehabilitation Centre – St-John’s, Newfoundland
Second year funding

Co-investigators:
Dr. Victoria Price, IWK Health Centre - Halifax, NS
Dr. Margaret Rand, Hospital for Sick Children - Toronto, ON
Dr. Julie Emberley, Janeway Children’s Health and Rehabilitation Centre – St-John’s, NL
Dr. Alfonso Iorio, McMaster University – Hamilton, ON
Dr. Tahani Ahmad, IWK Health Centre – Halifax, NS
Dr. Leonard Minuk, Cancer Care Manitoba – Winnipeg, MB
Ms. Sue Anne Hawes, IWK Health Centre – Halifax, NS
Ms. Lisa Thibeault, Kingston General Hospital – Kingston, ON
Dr. Anthony Chan, McMaster University, Hamilton, ON
Ms. Aidan Thomas, IWK Health Centre – Halifax, NS
Dr. Heather Scott, IWK Health Centre – Halifax, NS
Dr. Manohar Shroff, University of Toronto – Toronto, ON


Pregnancy, childbirth and the newborn period are times when there is a risk of significant bleeding problems for babies with hemophilia and other bleeding disorders, and for their mothers, who may also have bleeding disorders. Despite this risk, there is no standard way to provide care for these babies and their mothers, and there has been no good scientific study that shows that the care that is provided results in good outcomes. The Canadian Hemophilia Management in the Perinatal Setting (CHiMPS) study will find whether it is practical to collect information about these patients and their care. CHiMPS will also find out what medical care is being given to these patients. CHiMPS will also find out whether the care that is being given to these babies and their mothers results in low rates of bleeding complications or in low rates of exposure to unnecessary tests and medical treatments. This information will help doctors, nurses, and other health care professionals who are involved in the care of babies with bleeding disorders to develop more effective and more standardized ways of giving this care.


DDAVP vs exercise in patients with mild hemophilia A – which is better and do they work synergistically in improving hemostasis?


Dr. Manuel D. Carcao 
Hospital for Sick Children – Toronto
Second year funding (Start of project was delayed by two years)

Co-investigators:
Vanessa Bouskill, MN, RN(EC) Nurse Practitioner, Hospital for Sick Children – Toronto
Dr. Michelle Sholzberg, St. Michael’s Hospital – Toronto


To reduce the risk of bleeding, persons with hemophilia benefit from increasing their factor level in their blood. For persons with mild hemophilia A (MHA) this can be done by receiving DDAVP. DDAVP temporarily (≈12 hrs) increases the amount of FVIII in a person’s blood by shifting FVIII from sites of storage into the blood. DDAVP can be given as a nasal spray.

Our group showed that exercising for about 15 min on a stationary bicycle can increase FVIII in a similar way/extent as DDAVP. Thus exercise by itself may protect persons with MHA from bleeding and make taking DDAVP not necessary.

We wish to study this by testing 40 males (ages: 12-40) with MHA. They will be divided into two groups: Group 1 will receive DDAVP while Group 2 will undergo exercise. After that all subjects will have their blood rechecked. Then they will receive the other intervention to check if the combination of DDAVP plus exercise results in better clotting ability than just exercise or DDAVP alone.

We predict that exercise and DDAVP will result in similar effects on improving a person’s clotting ability. If successful the implications of our study will be that persons with MHA may not need to receive DDAVP but can feel reassured that they can exercise with less risk of bleeding provided that they appropriately warm up and thus raise their FVIII before engaging in sports activities that pose a risk of bleeding.


Bone Health in Symptomatic Carriers of Hemophilia A


Dr. Michelle Sholzberg
St. Michael’s Hospital – Toronto, Ontario
First year funding

Co-investigators:
Dr. Jerome Teitel, St. Michael’s Hospital
Dr. Paula James, Kingston General Hospital
Dr. Adrienne Lee, Foothills Medical Centre

Hemophilia is a genetic disorder of abnormal bleeding and men are most commonly affected. Studies have shown that men with hemophilia are more likely to have low bone strength and osteoporosis probably because of repeated bleeding into joints and muscles. Today, we know that women can also be affected by hemophilia. These women are called symptomatic hemophilia carriers. A recent study showed that carriers can also bleed into joints and that this can cause long term damage. We would like to study bone density in women who are carriers of hemophilia A around the time of menopause compared to women of the same age who are not carriers. We want to involve patients across Canada (Toronto, Kingston, Calgary) for this study. This will be the first study to explore bone health in hemophilia carriers. We think that we owe it to hemophilia carriers to better study how this genetic condition affects their bodies. We believe that our study has the potential to improve the care of hemophilia carriers worldwide.


Effects of two bouts of acute moderate-intensity exercise, repeated six hours apart, on hemostatic parameters in adult subjects with mild and moderate hemophilia A


Dr. Georges-Étienne Rivard
CHU Sainte-Justine – Montreal, Quebec
First year funding

Co-investigators:
Nichan Zourikian PT, CHU Sainte-Justine
Dr. Jean St-Louis, CHU Sainte-Justine/Maisonneuve-Rosemont

Hemophilia A is a disorder caused by decreased levels of coagulation factor VIII in the blood. It can lead to excessive bleeding following injuries, due to reduced clotting ability. Sport is recommended for individuals with hemophilia A to help improve overall health. Scientific studies suggest that a single session of exercise, such as cycling, can temporarily improve clotting ability in children and adults with mild/moderate hemophilia A. This improvement is due in part to an increased amount of factor VIII shortly after exercise. This increase may help temporarily protect against bleeds. It is not clear how long the effect lasts after exercise. This is what we want to determine. We also intend to see if two exercise sessions, instead of one, would cause a larger or longer effect. Thus, we will measure the amount of factor VIII in 40 adults (18-45 years old) with mild/moderate hemophilia A, before and after two short stationary cycling sessions, during the same day (one in the morning and one in the afternoon). Overall, our study may help to propose appropriate physical activity for each patient with mild/moderate hemophilia A, to help reduce the risk of bleeds and to improve their health.