Menaka Pai

Menaka Pai
McMaster University | McMaster · Department of Medicine

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60
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Introduction

Publications

Publications (60)
Article
Full-text available
Nirmatrelvir and ritonavir are two co-administered antiviral medications, marketed under the name Paxlovid in Canada, for the treatment of SARS-CoV-2 infection. Nirmatrelvir is an inhibitor of SARS-CoV-2 3CL-like protease that prevents polyprotein cleavage of proteins necessary for SARS-CoV-2 genome replication. Nirmatrelvir has been studied in com...
Article
Full-text available
This companion document outlines what prescribers and pharmacists need to know about nirmatrelvir/ritonavir for the treatment of COVID-19 in Ontario, including: - Why is nirmatrelvir/ritonavir used to treat COVID-19? - What is the benefit of nirmatrelvir/ritonavir for COVID-19? - Who should receive nirmatrelvir/ritonavir? - How do I dose nirmatrelv...
Article
Full-text available
Background Rare diseases are a global public health priority. Though each disease is rare, when taken together the thousands of known rare diseases cause significant morbidity and mortality, impact quality of life, and confer a social and economic burden on families and communities. These conditions are, by their nature, encountered very infrequent...
Article
Full-text available
Introduction There is concern about excessive bleeding when low-molecular-weight heparins (LMWHs) are used for venous thromboembolism (VTE) prophylaxis in renal dysfunction. Our objective was to evaluate whether LMWH VTE prophylaxis was safe and effective in critically ill patients with renal dysfunction by conducting a subgroup analysis of PROTECT...
Data
List of participating hospitals. (DOCX)
Article
Introduction: Care for persons with haemophilia (PWH) is most commonly delivered through the integrated care model used by Hemophilia Treatment Centers (HTCs). Although this model is widely accepted as the gold standard for the management of haemophilia; there is little evidence comparing different care models. Aim: We performed a qualitative st...
Article
Background: Haemophilia care is commonly provided via multidisciplinary specialized management. To date, there has been no systematic assessment of the impact of haemophilia care delivery models on patient-important outcomes. Objective: To conduct a systematic review of published studies assessing the effects of the integrated care model for per...
Article
Background: Rigorous and transparent methods are necessary to develop clinically relevant and evidence-based practice guidelines. We describe the development of the National Hemophilia Foundation-McMaster Guideline on Care Models for Haemophilia Management, which addresses best practices in haemophilia care delivery. Methods: We assembled a Pane...
Article
Full-text available
Background: Integrated care models have been adopted for individuals with chronic conditions and for persons with rare diseases, such as haemophilia. Objective: To summarize the evidence from reviews for the effects of integrated multidisciplinary care for chronic conditions in adults and to provide an example of using this evidence to make reco...
Article
This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplem...
Article
Background: Rivaroxaban is a direct oral anti-Xa inhibitor that has the potential to greatly simplify treatment of heparin-induced thrombocytopenia (HIT). Objectives: To evaluate the efficacy and safety of rivaroxaban in this patient population, we conducted a multicenter, single-arm, prospective cohort study of patients with suspected or confir...
Article
Rivaroxaban is an ideal potential alternative for treatment of heparin-induced thrombocytopenia because it is administered orally by fixed dosing, requires no routine coagulation monitoring and has been proven effective in the treatment of venous and arterial thromboembolism in other settings. The Rivaroxaban for HIT Study prospectively evaluated t...
Article
The impact of transfusing fresher versus older red blood cells on patient-important outcomes remains controversial. Two recently published large trials have provided new evidence. We summarized results of randomized trials evaluating the impact of the age of transfused red blood cells. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Database for...
Article
For unknown reasons, a small minority of critically ill patients with septic or cardiogenic shock, multi-organ failure, and disseminated intravascular coagulation (DIC) develop symmetrical acral (distal extremity) limb loss due to microvascular thrombosis ('limb gangrene with pulses'). Case reports have described preceding 'shock liver' in some cri...
Article
Background: Transfusing ABO-compatible blood avoids most acute hemolytic reactions, but donor units that are ABO compatible are not necessarily ABO identical. Emerging data have raised concerns that ABO-nonidentical blood products lead to adverse outcomes. Study design and methods: A large multihospital registry (Transfusion Registry for Utiliza...
Article
Full-text available
Rare diseases are a global public health priority; they can cause significant morbidity and mortality, can gravely affect quality of life, and can confer a social and economic burden on families and communities. These conditions are, by their nature, encountered very infrequently by clinicians. Thus, clinical practice guidelines are potentially ver...
Article
Benchmarking is a quality improvement tool that compares an organization's performance to that of its peers for selected indicators, to improve practice. Processes to develop evidence-based benchmarks for red blood cell (RBC) outdating in Ontario hospitals, based on RBC hospital disposition data from Canadian Blood Services, have been previously re...
Article
INTRODUCTION: Individuals with group O blood are designated ‘universal donors’ as their red cells can be transfused to all individuals. 15% of donors are Rh negative; their red cells are particularly valuable as they are the only blood compatible with O Rh negative recipients. Canada has experienced group O blood shortages in the past, which have b...
Article
To identify risk factors for failure of anticoagulant thromboprophylaxis in critically ill patients in the ICU. Multivariable regression analysis of thrombosis predictors from a randomized thromboprophylaxis trial. Sixty-seven medical-surgical ICUs in six countries. Three thousand seven hundred forty-six medical-surgical critically ill patients. Al...
Article
Limited evidence exists to guide the use of early parenteral anticoagulation following mechanical heart valve replacement (MVR). The purpose of this study was to compare the 30-day rates of thrombotic and bleeding complications for MVR patients receiving therapeutic versus prophylactic dose bridging regimens. In this retrospective cohort study we r...
Article
Background There is uncertainty regarding the optimal dosing regimen for resumption of warfarin after interruption for invasive procedures.AimTo determine the efficacy and safety of warfarin resumption with loading doses or with most recent maintenance dose.Methods Patients on warfarin treatment and planned for invasive procedures with expected hos...
Article
Rivaroxaban is an ideal potential candidate for treatment of heparin-induced thrombocytopenia (HIT) because it is administered orally by fixed dosing, requires no laboratory monitoring and is effective in the treatment of venous and arterial thromboembolism in other settings. The Rivaroxaban for HIT study is a prospective, multicentre, single-arm,...
Article
Background: Limited evidence exists to guide the use of parenteral anticoagulation in the early postoperative period following mechanical valve replacement (MVR). The purpose of this study was to determine the practice patterns of anticoagulant management in patients undergoing MVR and to compare the 30 day rates of thrombotic and bleeding complica...
Article
Heavy menstrual bleeding (HMB) is a common clinical problem; population-based studies estimate that approximately 10-35% of women report this symptom during their lifetime, while about 5% of women consult a physician for evaluation of HMB. Patients with HMB account for 15% of all referrals to gynaecologists and are frequently seen by haematologists...
Article
Full-text available
Background Venous thromboembolism (VTE) is a common preventable cause of mortality in hospitalized medical patients. Despite rigorous randomized trials generating strong recommendations for anticoagulant use to prevent VTE, nearly 40% of medical patients receive inappropriate thromboprophylaxis. Knowledge-translation strategies are needed to bridge...
Article
Heparin is the mainstay in the treatment and prevention of thrombosis in such diverse clinical settings as venous thromboembolism, acute coronary syndrome, cardiopulmonary bypass, and hemodialysis. However, the major complication of heparin - like that of all anticoagulants - is bleeding. Heparin may need to be reversed in the following settings: c...
Article
Deep vein thrombosis (DVT) prophylaxis remains underused in hospitalized medical patients despite strong recommendations that at-risk patients should receive prophylaxis. To understand this gap between knowledge and practice, we surveyed clinicians' perceptions about the importance of DVT prophylaxis, barriers to guideline implementation, and inter...
Article
Critical values are vital to safe clinical and laboratory practice. To address the lack of information on critical values in coagulation, pattern-of-practice surveys were distributed to members of the North American Specialized Coagulation Laboratory Association. More than 70% of respondents had critical values for commonly performed tests. Median...
Article
Light transmission platelet aggregometry (LTA) is important to diagnose bleeding disorders. Experts recommend testing LTA with native (N) rather than platelet count adjusted (A) platelet-rich plasma (PRP), although it is unclear if this provides non-inferior, or superior, detection of bleeding disorders. Our goal was to determine if LTA with NPRP i...
Article
Platelet dense granule release assays are recommended for diagnosing platelet function disorders and are commonly performed by Lumi-Aggregometer (Chrono-Log, Havertown, PA) assays of adenosine triphosphate (ATP) release. We conducted a prospective cohort study of people tested for ATP release defects to assess bleeding symptoms. Reduced release, wi...
Article
Fondaparinux is theoretically an attractive agent for the treatment of immune heparin-induced thrombocytopenia (HIT), a prothrombotic disorder caused by platelet-activating anti-platelet factor 4/heparin antibodies. Although reports of the use of fondaparinux for this indication have thus far been favorable, the diagnosis of HIT in most cases was n...
Article
Studies have established a relationship between inflammation and venous thromboembolism (VTE). Though statins modulate inflammation, it is uncertain if they prevent VTE in heterogeneous populations. A recent randomized trial demonstrated that statins prevent VTE in healthy older adults, yet this has not been well established in other groups, includ...
Article
In hospitalized medical patients, randomized trials have established that anticoagulant prophylaxis has an acceptable benefit-to-risk ratio: ie, it lowers the incidence of clinically silent and symptomatic venous thromboembolism (VTE), including fatal pulmonary embolism, more than it raises the risks of bleeding and other complications. However, no...
Article
1415 Poster Board I-438 Introduction Critical laboratory values (CVs) are those that indicate the patient is in danger of death unless corrective action is initiated immediately. CVs are an important feature of laboratory practice parameters, standards of regulatory agencies (including the Joint Commission's National Patient Safety Goals), and nat...
Article
1314 Poster Board I-338 Background Platelet secretion defects are a common type of inherited platelet disorder. Experts agree that ATP release assays are often helpful to assess for platelet secretion disorders among individuals with suspected bleeding problems. However, the diagnostic utility of ATP release assays has not been established, and it...
Article
The platelet disorders are a group of heterogeneous, congenital and acquired bleeding disorders associated with impaired platelet function. There is a growing interest in standardizing the assessment of these disorders, but this is challenged by their heterogeneity, the absence of widely accepted diagnostic criteria, and inconsistency in laboratory...
Article
Light transmission aggregometry (LTA) is commonly performed to assess individuals for bleeding disorders. The goal was to evaluate the incidence and spectrum of platelet function abnormalities in a prospective cohort of individuals referred for bleeding disorder assessments after exclusion of thrombocytopenia and von Willebrand disease. Subjects we...
Article
Background: The value of gender-specific questions in assessing patients for bleeding problems is not well established, nor is the impact of bleeding on sexual and reproductive health. Methods: We administered the CHAT (clinical history assessment tool) to 256 females and 66 males referred for bleeding problems, and 67 female and 32 male healthy co...
Article
Light transmission platelet aggregation tests are important for diagnosing platelet function defects. However, uncertainties exist about the best procedures to determine aggregation reference intervals. We investigated methods for determining reference intervals for light transmission aggregation tests, using the % maximal aggregation values for pr...
Article
Introduction: The value of gender-specific questions in assessing patients referred for evaluation of bleeding problems is not well established. Moreover, the impact of having a bleeding problem on sexual health is unknown. Methods: To learn more about gender differences in bleeding problems, questions about bleeding affecting sexuality and gender-...
Article
Hypertension is common in patients with atrial fibrillation (AF) and is an important cause of stroke. To determine how effectively hypertension is managed among specialist-treated outpatients with AF. Investigators reviewed the charts of patients with a diagnosis of AF cared for by medical specialists to determine the change in blood pressure, patt...
Article
Von Willebrand disease (VWD) is the commonest inherited disorder of hemostasis and the majority of women with this disorder experience excessive uterine bleeding. Yet very little information is available on the health-related quality of life (HRQL) in individuals with VWD. To test the a priori hypotheses that these individuals will have poorer HRQL...
Article
In response to the transfusion- transmitted AIDS epidemic, Canadian authorities recommended the development of tracking systems and improved reporting of adverse events. This study describes the development of a verifiable and comprehensive regional tracking system for coagulation factor concentrates. The Hamilton- Niagara Regional Hemophilia Progr...
Article
Venous thromboembolic disease (VTE) is a major cause of morbidity and mortality in hospitalized patients. Most hospitalized patients with a fatal pulmonary embolism are medical patients who do not have a history of recent surgery [BMJ 302 (1991) 709; J. R. Soc. Med. 82 (1989) 198]. There is evidence suggesting that VTE prophylaxis is indicated in m...
Article
The hemophilias are a group of disorders associated with a chronic burden of morbidity and early mortality. Improvements in these adverse features have been achieved by the use of clotting factor concentrates within comprehensive centers of specialized care providing home infusion programs. Offsetting effects from transfusion-transmitted hepatitis...
Article
The Quebec platelet disorder (QPD) is an autosomal dominant platelet disorder associated with delayed bleeding and alpha-granule protein degradation. The degradation of alpha-granule, but not plasma, fibrinogen in patients with the QPD led to the investigation of their platelets for a protease defect. Unlike normal platelets, QPD platelets containe...
Article
Multimerin is a massive, soluble, homomultimeric, factor V-binding protein found in platelet alpha-granules and in vascular endothelium. Unlike platelets, endothelial cells contain multimerin within granules that lack the secretory granule membrane protein P-selectin, and in culture, they constitutively secrete most of their synthesized multimerin....
Article
Multimerin is a massive, soluble, homomultimeric, factor V-binding protein found in platelet -granules and in vascular endothelium. Unlike platelets, endothelial cells contain multimerin within granules that lack the secretory granule membrane protein P-selectin, and in culture, they constitutively secrete most of their synthesized multimerin. To...
Article
Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is the most preventable cause of death in hospitalized patients. Due to its high mortality, morbidity, and cost, health care providers are obligated to not only effectively diagnose and treat VTE, but also to prevent it if possible. This has been...

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