Keyvan Karkouti

Research Synopsis

Dr. Karkouti’s research has made significant contributions to our understanding of the prognostic importance and limits of tolerance in perioperative anemia. His article entitled ‘Risk associated with preoperative anemia in cardiac surgery: A multi-center cohort study’ (Circulation 2008; 117:478-484) addresses the prognostic value of preoperative anemia. Another article entitled ‘The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery’ (Transfusion 2008;48:666-672) identifies a 50% drop in hemoglobin as the threshold beyond which the risk for adverse events increase in non-anemic cardiac surgical patients.

Dr. Karkouti’s research has also had a major impact in establishing the relationship of perioperative anemia and blood transfusion with acute kidney injury in cardiac surgery.  His work in ‘Acute kidney injury after cardiac surgery: focus on modifiable risk factors’ (Circulation 2009; 119:495-502) led to a novel and testable hypothesis on why transfusing older blood may lead to organ injury and how it may be avoided.  This is a highly topical question with important clinical implications. He is currently pursuing this line of research and completed a pilot clinical trial (Karkouti et al. Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial. Anesthesiology 2012; 116:613-621), and established a multidisciplinary, international team of investigators to conduct a definitive trial. 

Dr. Kartouki’s research group has conducted high-impact clinical trials in the area of Blood Conservation and Management of Coagulopathy in Cardiac Surgery with findings presented to the U.S. Food and Drug Administration and Health Canada. These findings influenced the recommendations for the use a major hemostatic drug (aprotinin).  His group has been influential in delineating the role of important hemostatic drugs in clinical practice, such as recombinant factor VII, Factor XIII, and aprotinin.  His group recently developed a novel blood management algorithm in cardiac surgery that employs point-of-care coagulation assays.  

Recent Publications

1. Bartoszko J, Peer M, Grewal D, Ansari S, Callum J, Karkouti K. Delayed cold-stored vs. room temperature stored platelet transfusions in bleeding adult cardiac surgery patients—a randomized multicentre pilot study (PLTS-1) 2024.
2. Khan JS, Gilron I, Devereaux PJ, Clarke H, Ayach N, Tomlinson G, Quan ML, Ladha KS, Choi S, Munro A, Brull R, Lim DW, Avramescu S, Richebé P, Hodgson N, Paul J, McIsaac DI, Derzi S, Zbitnew GL, Easson AM, Siddiqui NT, Miles SJ, Karkouti K. Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial 25(1) 2024 
3. Martinelli ES, McCluskey SA, Karkouti K, Luzzi CA, Bieze M, Malbouisson LMS, Schmidt AP. The debate on antifibrinolytics in liver transplantation: always, never, or sometimes? 74(6) 2024
4. Bartoszko J, Miles S, Ansari S, Grewal D, Li M, Callum J, McCluskey SA, Lin Y, Karkouti K. Postoperative intravenous iron to treat iron-deficiency anaemia in patients undergoing cardiac surgery: a protocol for a pilot, multicentre, placebo-controlled randomized trial (the POAM trial) 2024
5. Karkouti K, Callum J, Bartoszko J, Solomon C, Knaub S, Levy JH, Tanaka KA. Protocol for a phase 3, randomised, active-control study of four-factor prothrombin complex concentrate versus frozen plasma in bleeding adult cardiac surgery patients requiring coagulation factor replacement: the LEX-211 (FARES-II) trial 14(8):e091381 2024
6. Co-authors:Sibai J, Karkouti K, McCluskey SA. Improving blood transfusion practice: to give or to consider 71(7):939-943 2024
7. Chen M, Santa Mina D, Au D, Karkouti K, Alibhai S, Zywiel M, Randall I. Hospital-perspective cost-analysis of a nonrandomized trial of prehabilitation before major elective surgery 71(4):550-552 2024

Appointments

Vice Chair of Clinical Affairs, Department of Anesthesiology & Pain Medicine 

Anesthesiologist-in-Chief, University Health Network, Sinai Health System, Women’s College Hospital, Centre for Addiction and Mental Health, and the Kensington Institute, Anesthesia and Pain Management

Research Director, University Health Network, Sinai Health System, and Women’s College Hospital, Department of Anesthesia and Pain Management

Senior Scientist, Toronto General Hospital Research Institute

Professor, Institute of Health Policy, Management, and Evaluation, Anesthesia and Pain Medicine