This is an opinion column by Niagara Health Communications Specialist Tiffany Mayer, originally published in the St. Catharines Standard, Niagara Falls Review and Welland Tribune.
Paul and Margaret Brady at their home in Niagara Falls. Paul was one of the first patients enrolled in a clinical study in Niagara Health's neurology research program.
When Paul Brady suffered a stroke 14 years ago, he was prescribed blood thinners he figured he’d have to take for the rest of his life.
After a serious fall last year brought him under the care of Niagara Health stroke neurologist Dr. Danielle de Sa Boasquevisque, his treatment plan changed -- and his experience is helping to redefine the standards of stroke care around the world.
Brady, 84, was one of the first patients enrolled in Niagara Health’s neurology research program, launched last year by the neurology team, including Dr. de Sa Boasquevisque. He’s participating in the ENRICH-AF clinical trial, a global study exploring whether the blood thinner edoxaban can reduce overall stroke risk in atrial fibrillation (AFib) patients with a history of brain bleeding, without increasing the chance of re-bleeding compared to the standard treatment, typically aspirin.
“I was one of the first ones in that program in Niagara,” Brady said. “I think it’s wonderful we’re doing this kind of work here.”
Brady was 70 when he had a stroke. It was compounded by the Niagara Falls resident’s AFib diagnosis, making blood thinners a critical part of his recovery and future stroke prevention. AFib is an irregular heartbeat that disrupts blood flow and can set the stage for blood clots to form, leading to a stroke.
Life eventually returned to normal for Brady. Originally from Ireland, he continued his “physiotherapy” of playing guitar in a band and singing his favourites, Danny Boy, and the Johnny Cash anthem Sunday Morning Coming Down. He also carried on his post-retirement work as a school bus monitor.
“Patients who undergo research studies have a special personality. They have objectives like helping other people."
Dr. Danielle de Sa Boasquevisque, Stroke Neurologist.
Those routines were disrupted in July 2023 after Brady fell while getting out of bed, hitting his head and suffering a hematoma, which is the pooling of blood in the brain.
Doctors at the Niagara Falls Hospital initially stopped his blood thinners but a follow-up appointment led to their reintroduction to his medication regimen. This time, though, their effects weren’t quite as positive.
“No matter what I looked at, everything was moving around,” Brady said.
“When he went back on blood thinners, all he was doing was sleeping and that was a concern,” Brady’s wife, Margaret, recalled. “But we knew he had a CT scan coming up and would see what was going on.”
The results of that CT scan, which happened about two months after his fall, landed in Dr. de Sa Boasquevisque’s hands. The couple said she was immediately concerned about what she saw.
She told the couple to stop taking blood thinners until she could re-assess further and to return to the hospital immediately.
“The problem was not the blood thinners, per se, but the timing of resuming them, which is decided case by case,” Dr. de Sa Boasquevisque said.
After five days in hospital in Hamilton to drain the pooling blood, Brady returned to the Niagara Falls Hospital and was invited to participate in the ENRICH-AF study. It was the first clinical trial in the neurology research program, which now boasts six trials under Dr. de Sa Boasquevisque as the program’s physician lead and principal site investigator.
Edoxaban is already an approved blood thinner used for preventing strokes in people with AFib, but the trial, which will take three years across 250-300 global sites, is exploring how it performs in certain patient groups to further refine its use.
Participating was an easy sell for the couple.
“I said, ‘At least they’re going to be keeping an eye on you,’” Margaret said. “Being in the trial, I thought they’d give him attention a little more.”
As part of the trial, Brady checks in with Dr. de Sa Boasquevisque and research co-ordinator Joanne Gorman every six months. A patient’s decision to be part of a clinical trial is a selfless act, she noted.
“Patients who undergo research studies have a special personality. They have objectives like helping other people,” Dr. de Sa Boasquevisque said. “It’s nice to see how, when they come into an appointment, they’re happy and you get to know that patient more. It’s definitely a more in-depth relationship.
“They’re doing a huge favour for us but also for the community,” she added. “It takes a lot for them to say, ‘I want to do that.’ We really appreciate these patients.”
The neurology research program is one of eight clinical trial and research programs happening at Niagara Health under its Niagara Health Knowledge Institute (NHKI) banner. Trials are also being held in cardiology, oncology, critical care, thrombosis and emergency medicine, among others.
While the participants may be special, they also get access to novel, cutting-edge treatments normally reserved for patients in academic hospitals in larger centres. They are treatments poised to become the next standard of care that people in Niagara might otherwise have to wait years to access.
“These are trials that are very important for the community,” Dr. de Sa Boasquevisque said. “Many of the principal investigators on these trials are international experts who used to be my mentors and are now colleagues. It’s nice to have a close relationship with the patients going through trials and seeing that your institution is able to contribute to solutions rather than waiting for results from research done somewhere else.”
So far, Brady is feeling fine, and continuing to croon with his bandmates. When the ENRICH-AF clinical trial ends, he’ll continue in Dr. de Sa Boasquevisque’s care and know that, in addition to his own healing, he will help other people achieve better health, too.
“Somebody has to do the studies. It’s not hurting you,” Margaret said, turning to her husband. “It’s helping you.”
