Professor  |  Chief, Department of Anesthesia and Pain Management - University Health Network; Sinai Health System; Women's College Hospital

Keyvan Karkouti



University Health Network - Toronto General Hospital
200 Elizabeth Street, 3EN-464, Toronto, Ontario Canada M5G 2C4
Research Interests
cardiovascular anesthesia, perioperative patient management
Clinical Interests
cardiovascular anesthesia, perioperative patient management
Appointment Status
contact faculty member for more information

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. Corredor C, Wasowicz M, Karkouti K, Sharma V. The role of point-of-care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta-analysis. Anaesthesia. 2015 Jun. Epub ahead of print. Coauthor or Collaborator.
  2. Mace H, Lightfoot N, McCluskey S, Selby R, Roy D, Timoumi T, Karkouti K. Validity of Thromboelastometry for Rapid Assessment of Fibrinogen Levels in Heparinized Samples During Cardiac Surgery: A Retrospective, Single-center, Observational Study. J Cardiothorac Vasc Anesth. 2015 May. Epub ahead of print. Senior Responsible Author.
  3. Karkouti K, Grocott HP, Hall R, Jessen ME, Kruger C, Lerner AB, MacAdams C, Mazer CD, de Medicis E, Myles P, Ralley F, Rheault MR, Rochon A, Slaughter MS, Sternlicht A, Syed S and Waters T. Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study. Can J Anaesth. 2015 Apr;62(4):377-384. Principal Author.
  4. Karkouti K, McCluskey SA, Callum J, Freedman J, Selby R, Timoumi T, Roy D and Rao V. Evaluation of a novel transfusion algorithm employing point-of-care coagulation assays in cardiac surgery: a retrospective cohort study with interrupted time-series analysis. Anesthesiology. 2015 Mar;122(3):560-70. Principal Author.
  5. Mace HS, Lightfoot NJ, Cordero-Rochet MJ, Srinivas C, Karkouti K and McCluskey SA. Reliability of a point-of-care device for international normalized ratio testing during the three surgical phases of orthotopic liver transplantation: a retrospective observational study. Can J Anaesth. 2015 Mar;62(3):258-64. Coauthor or Collaborator.
  6. Orlov D and Karkouti K. The pathophysiology and consequences of red blood cell storage. Anaesthesia. 2015 Jan;70(Suppl 1):29-37:e9-12. Senior Responsible Author.
  7. Karkouti K, McCluskey SA. Revision of Evaluation of a Novel Transfusion Algorithm Employing Point-of-Care Coagulation Assays in Cardiac Surgery:  A Retrospective Cohort Study with Interrupted Time-Series Analysis due to Anesthesiology. Anesthesiology. 2014 Nov. In Press. Principal Author.
  8. Karkouti K, Arellano R, Aye T, Dupuis JY, Kent B, Lee TW, Lin Y, Ralley F, MacAdams C, Mazer CD, Muirhead B, Rheault MR, Rochon A, Syed S, Waters T and Wong B. Off-label use of recombinant activated factor VII in surgical and non-surgical patients at 16 Canadian hospitals from 2007 to 2010 (Canadian Registry Report). Can J Anaesth. 2014 Aug;61(8):727-35. Principal Author.
  9. Karkouti K. From the Journal archives: The red blood cell storage lesion: past, present, and future. Can J Anaesth. 2014 Jun;61(6):583-6. Principal Author.
  10. Dyke C, Aronson S, Dietrich W, Hofmann A, Karkouti K, Levi M, Murphy GJ, Sellke FW, Shore-Lesserson L, von Heymann C and Ranucci M. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014 May;147(5):1458-1463.e1. Coauthor or Collaborator.



Senior Scientist, Toronto General Hospital Research Institute
Interim Director of Anesthesia Research, Toronto General Site



Course Number: 1:1 teaching in operating room
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