INNOVATION NOTEBOOK
Clot-busting drugs
Powerful, but risky, clot-busting drugs are not needed by all patients with blood clots in their legs, Hamilton researchers have concluded. Clearing the clot with medication and specialized devices did not reduce the risk of a complication known as post-thrombotic syndrome, which can leave patients with longterm leg pain and swelling that leads to difficulty walking. But it increased the chances of a dangerous bleed, reveals the study by researchers at McMaster University, Hamilton Health Sciences and led by Washington University, Massachusetts General Hospital and St. Luke’s MidAmerica Heart Institute in Kansas City. The benefits may still outweigh the risks for some deep vein thrombosis patients, particularly those with exceptionally large clots, found the research published Thursday in the New England Journal of Medicine. The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) study randomized 692 patients to receive blood thinners alone, or the drugs plus a procedure, and followed them for two years. The study had a number of funders, including the National Heart, Lung and Blood Institute in the United States, Washington University’s Center for Translational Therapies in Thrombosis and Washington University’s Institute of Clinical and Translational Sciences. It also received support from industry, including Boston Scientific, Covidien (now Medtronic), Genentech and BSN Medical.
Spinal tap
The needle used during a spinal tap makes a big difference in decreasing headaches, nerve irritation and hearing disturbance in patients, found a Hamilton study. The pencil-point atraumatic needle reduced headaches, emergency room visits and hospital readmission after lumbar punctures, by more than 50 per cent, concludes the research published Wednesday in the Lancet. But it costs up to three times more than the normally used beveled traumatic needles. The atraumatic needle has been around for about 70 years, but few doctors use it because they don’t know it can significantly decrease complications, say the researchers from Hamilton Health Sciences and McMaster University. It’s significant considering spinal taps used to diagnose and treat disease can cause headaches in about one-third of patients, sometimes causing debilitating pain. The difference is how the two types of needles penetrate the thick membrane surrounding the nerves, called the dura. The conventional needle cuts its way through, while the tip of the atraumatic needle causes the tissue to dilate and contract around it, leaving a tiny hole that significantly reduces the chance of cerebrospinal fluid leaking through. The study used no external funding and pooled data from 30,000 patients in 110 clinical trials done in 29 countries.
Treating cystic fibrosis
A Hamilton researcher is getting just over $280,000 to improve personalized treatment for cystic fibrosis patients. Dr. Jeremy Hirota, of St. Joseph’s Healthcare, was awarded a New Investigator Research Grant to create a tool that will work faster to come up with the best combination of drugs for each patient. The grant given by the SickKids Foundation, and the Canadian Institutes of Health Research, will focus on precision medicine, which works by testing combinations of different drugs. Hirota will combine precision medicine with a new technology called microfluidics, which is the study of tiny volumes of liquids. The hope is that the resulting device will require smaller samples from patients and work faster to find the best combination of drugs tailored to the patient. Cystic fibrosis is the most common fatal disease affecting Canadian children and youth.
Genes ‘snowball’ obesity
Nine genes make you gain more weight if you already have a high body mass index, McMaster University researchers have revealed. “It’s similar to a tiny snow ball at a top of a hill that becomes bigger and bigger when rolling down the hill,” David Meyre, an associate professor who holds the Canada research chair in genetics of obesity. He helped author a study looking at 37 genes already linked with body mass index and found the nine with the snowball effect. “These genes may, in part, explain why some individuals experience uncontrolled and constant weight gain across their life, despite the availability of different therapeutic approaches,” Meyre said. The study of 73,230 adults with European ancestry was published Thursday in the American Journal of Human Genetics.