Cardiovascular Disease

Factor Xa Inhibitors and Major Bleeding (AXIOM)

On an annual basis approximately 4–6% of patients that receive oral anticoagulants (OAC) therapy will suffer from a major bleed or require urgent surgery involving anticoagulant reversal therapy. Over the past decade, increasing concern has been raised about the risks of major bleed from Factor Xa inhibitors (FXai) and other direct oral anticoagulants. The AXIOM study aims to estimate the incidence of and risk factors for major bleeding during FXai use. Further primary objectives of the study include:

  • Describe the patient characteristics of individuals with a major bleeding event during FXai use.
  • Estimate the incidence of and risk factors for all-cause mortality, cardiovascular death, acute myocardial infarction, stroke, acute kidney and liver failure in patients with a first major bleeding event in temporal association with FXai treatment.
  • Estimate the healthcare resource use following major bleeding in patients with a first major bleeding event in temporal association with FXai treatment.

The CVC is the Canadian Arm of this international study, which utilizes administrative health databases from Canada, United Kingdom, Germany, Netherlands, and Spain.

CVC Faculty Involvement:
Robert Welsh, MD
Padma Kaul, PhD

Using Novel Approaches for the Early Recognition of Transient Ischemic Attack, Heart Failure and Connections with Vascular Dementia (UNEARTH CVD)

The central aim of the UNEARTH CVD project is to improve early recognition and outcomes for those with heart-brain related conditions. This project is a Canada-wide initiative with more than 50 investigators, and the Alberta-based analysis is led by Dr. Finlay McAlister. This analysis will utilize large alberta-based cohorts and data platforms to examine social disparities in health and virtual care for patients with transient ischemic attack, stroke, and heart failure.

CVC Faculty Involvement:
Finlay McAlister, MD, MSc

Vital Heart Response (VHR)

Dr. Robert Welsh established the VHR Program in 2006 in collaboration with Alberta Health Services. VHR introduced a cutting-edge approach for delivering life-saving treatment to heart attack patients faster. The program works closely with a team of remote cardiologists to recommend a course of treatment based on ECG results, and highly-trained Emergency Medical Response (EMS) paramedics to administer specialized clot-busting drugs for patients with a ST-elevation myocardial infarction (STEMI) heart attack before they arrive at the hospital. This model of STEMI care has substantially improved outcomes for this high-risk patient population and is now utilized in other regions both nationally and internationally.

Data from VHR have been used for several research projects, including:

  • Describing contemporary use of novel anti-platelet therapies in patients with STEMI.
  • Describing angiographic, clinical and electrocardiographic outcomes in patients treated early with aspirin/clopidogrel versus aspirin/ticagrelor, with and without percutaneous coronary intervention.
  • Informing treatment times and choices, thereby monitoring quality of care.
  • Assessing short and long term clinical outcomes.
  • Providing insight into care gaps and opportunities for future research.


CVC Faculty Involvement:
Robert Welsh, MD
Kevin Bainey, MD, MSc
Paul W. Armstrong, MD

Publications: