2023–2025 Merit Awards Impact: Drs. Keyvan Karkouti and James Khan

Excellence in Research Award

Dr. Keyvan Karkouti is advancing perioperative care through research aimed at optimizing coagulation management in adult cardiac surgery. With support from the Excellence in Research Merit Award, he is leading a multicentre randomized controlled trial comparing four-factor prothrombin complex concentrate (PCC) with frozen plasma in bleeding cardiac surgery patients who require coagulation factor replacement.

For patients experiencing excessive bleeding during cardiac surgery related to coagulation factor deficiency, the standard treatment has traditionally been transfusion of frozen plasma. PCC, which contains key coagulation factors, offers several advantages over frozen plasma: it has undergone purification, concentration, and pathogen reduction; contains a standard amount of coagulation factors; and does not require thawing or ABO matching. These features led Dr. Karkouti’s team to study PCC as a potential alternative to improve hemostatic management.

The main study, published this year in JAMA, found that PCC provided better hemostatic control, reduced the need for transfusions, and was associated with fewer serious adverse events, including a lower risk of acute kidney injury, demonstrating clear safety and efficacy advantages over frozen plasma. The study has garnered significant attention and influenced clinical practice, and an accompanying editorial highlighted its potential to change standard coagulation management in cardiac surgery.

Subsequent papers are in preparation, and Dr. Karkouti is submitting a follow-up study for funding to further refine coagulation management in bleeding cardiac surgery patients. Emphasizing the importance of translating research into practice, he notes, “I would not be where I am without the support made possible by the Merit Awards.” His work aims to improve patient safety, reduce transfusion risks, and guide clinicians in managing perioperative bleeding.

Early Investigator Award

Dr. James Khan is leading an integrated clinical research program focused on improving the prediction, prevention, and treatment of chronic postsurgical pain, a common and often debilitating long-term complication after surgery. Supported by several peer-reviewed grants, his work includes mechanistic studies, systematic reviews, and multicentre randomized trials evaluating new approaches to prevent chronic pain.

A key part of his program is the prevention of persistent pain following orthopedic and cancer surgery. With funding from the Canadian Institutes of Health Research (CIHR), Dr. Khan is launching the PROVISION trial to determine whether perioperative vitamin C can reduce chronic pain after total knee arthroplasty. He also leads the international PLAN Trial (n=1,602), which evaluates lidocaine infusions for preventing chronic pain after breast cancer surgery. The trial is recruiting across 17 international centres which include 15 centres in North America, 1 centre in Africa, and 1 centre in Asia, reflecting a global network focused on reducing chronic postsurgical pain.

His team’s systematic reviews and meta-analyses are helping shape evidence-based strategies for novel treatment strategies for chronic pain. For example, a recent study published in Pain Management found that peripheral magnetic stimulation (PMS) was associated with reduced pain scores in fibromyalgia patients over one to three months. Dr. Khan’s work has also reached national audiences through interviews in Global News, CP24, VITA Magazine, STYLE Canada, and ZoomerTV.

His goal is to “build a clinical research program focused on novel interventions to prevent and treat chronic pain disorders,” Dr. Khan explains. Looking ahead, his Prevention of Persistent Pain Clinical Trials Group, supported by a departmental Anesthesia Research Cluster Grant, will continue advancing innovative perioperative approaches, including ongoing multicentre trials such as PLAN and PROVISION, to generate high-quality evidence that reduces chronic pain and improves long-term recovery for surgical patients.