Deborah Siegal

Advancing safer anticoagulant treatment and optimal transfusion practices

My research program focuses on improving anticoagulant safety and optimizing transfusion practices to minimize the harms of bleeding. Through pragmatic clinical trials, large-scale clinical data, and close collaboration with patients and health system partners, my research generates evidence that directly informs clinical practice and policy.

Impact

My work has:

• Informed international clinical practice guidelines
• Improved understanding of anticoagulant-related bleeding risk and outcomes
• Influenced how anticoagulant therapy is managed after bleeding
• Supported evidence-based, patient-centred cardiovascular care

Research Focus Areas

1. Prevention and management of anticoagulant-related bleeding

Anticoagulant medications save lives by preventing stroke and blood clots, but they also carry a risk of bleeding. My work aims to optimize the balance between benefit and harm, particularly for patients with complex clinical profiles who are often under-represented in traditional trials. This work examines bleeding risk, predictors, and outcomes, as well as prevention and management strategies after a bleeding event, with the goal of improving patient safety and informing evidence-based clinical decision-making.

This work helps clinicians better understand real-world bleeding risk, prognostic factors, and opportunities to improve post-bleed management.

2. Optimization of perioperative anticoagulant management

My research addresses the challenges of managing anticoagulation around surgery and invasive procedures. Specific areas include evaluating perioperative management such as anticoagulant interruption, bridging, and resumption strategies to reduce both bleeding and thrombotic complications, supporting safer and more consistent perioperative care for patients receiving anticoagulants.

This work helps clinicians optimize the management of anticoagulants before and after surgery including innovative pragmatic approaches.

3. Prevention and treatment of cancer-related stroke

Cancer-related stroke is an increasingly recognized and complex clinical problem. This research focuses on improving the prevention and treatment of stroke in patients with cancer, addressing important evidence gaps related to anticoagulant and antithrombotic therapy in this high-risk population.

This work leverages information from population-based cohorts to inform personalized treatment decisions.

4. Reduction of transfusion in hospitalized patients

Blood transfusion is common in hospitalized patients, particularly those with critical illness and undergoing cardiac surgery, and carries important risks. This research area focuses on strategies to reduce transfusion using pragmatic trials embedded within clinical practice, while maintaining patient safety and promoting evidence-based use of blood products.

This work involves designing and leading pragmatic clinical trials embedded in routine clinical care of patients. The goal is to produce evidence that is immediately applicable at the bedside.

How We Work

My research program is built on:

• Innovative pragmatic cluster-randomized trials and traditional randomized trials
• Large, high-quality population-based datasets
• Multidisciplinary collaboration with clinicians, statisticians, methodologists, and trainees
• Patient partnership to ensure research questions and outcomes reflect what matters most to patients
• Integrated knowledge translation through guidelines, education, and clinical tools

Training and Mentorship

Training the next generation of clinician-scientists is a central mission of my program. Trainees gain experience in:

• Clinical trial and observational study design
• Advanced data analysis and interpretation
• Scientific writing and knowledge translation
• Patient-partnered research and equity-informed methods

I support learners at all stages, from students to early-career investigators, in a collaborative and inclusive research environment.