Joseph Shaw

Joseph R. Shaw, MD, MSc, FRCPC, DRCPSC, is a hematologist and thrombosis medicine specialist at The Ottawa Hospital and an Associate Scientist in the Inflammation and Chronic Disease Program at the Ottawa Hospital Research Institute (OHRI). He is an Assistant Professor in the Division of Hematology, Department of Medicine, with a cross-appointment to the School of Epidemiology and Public Health, at the University of Ottawa. He holds the Department of Medicine Early Career Investigator Chair and is Director of the Research+ Program. 

Dr. Shaw leads a clinical and translational research program in thrombosis, hemostasis, and anticoagulation. His research integrates anticoagulant pharmacokinetics and pharmacodynamics, direct oral anticoagulant (DOAC) measurement, thrombin generation assays, coagulation biomarkers, and clinical outcomes to improve perioperative anticoagulation management, anticoagulant-associated bleeding and reversal, and the investigation of breakthrough thrombosis during anticoagulant therapy. His work spans venous thromboembolism (VTE), atrial fibrillation, and high-risk populations including patients with active cancer, mechanical heart valves, chronic kidney disease, and thrombotic antiphospholipid syndrome. 

Dr. Shaw co-leads PAUSE-2, a CIHR-funded multicentre randomized trial comparing perioperative DOAC management strategies for patients undergoing high-bleed-risk surgery or neuraxial procedures, and ACE-HIGH, a CIHR-funded multicentre prospective management study of perioperative anticoagulation in patients with active cancer. He is Principal Investigator of CODEBREAKER, funded through the University of Ottawa Faculty of Medicine Translational Research Grant, which seeks to define clinically actionable pharmacodynamic anticoagulation targets using thrombin generation. He also led GAUGE, a prospective cohort study evaluating four-factor prothrombin complex concentrate in factor Xa inhibitor-associated major bleeding or urgent surgery. 

Recent major contributions include:

• The SONAR study of perioperative direct oral anticoagulant levels, thrombin generation, and bleeding. This nested case-control and causal mediation study linked higher residual preoperative DOAC concentrations with postoperative bleeding and showed that this association was partly mediated through impaired thrombin generation. The findings provide a mechanistic basis for more individualized perioperative anticoagulant assessment. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2521-0923 
• ISTH SSC guidance on surgical and procedural bleeding-risk stratification. Dr. Shaw led this international, multidisciplinary guidance, which provides a standardized framework for classifying the bleeding risk of surgeries and procedures in anticoagulated patients. The framework supports more consistent perioperative anticoagulation decisions, institutional protocols, clinical research, and future guideline development. https://www.jthjournal.org/article/S1538-7836(26)00055-3/abstract 
• The GAUGE prospective study of prothrombin complex concentrate in factor Xa inhibitor-associated bleeding and urgent surgery. In 101 episodes, the study showed that four-factor prothrombin complex concentrate increased thrombin generation without reducing factor Xa inhibitor levels. These findings clarify its role as a nonspecific prohemostatic therapy rather than a direct anticoagulant reversal agent. https://ashpublications.org/bloodadvances/article/10/15/5378/569098/Effect-of-PCC-on-thrombin-generation-in-patients 
• A BMJ State of the Art Review on breakthrough ischemic stroke in anticoagulated patients with atrial fibrillation. This review provides a structured approach to investigating and managing ischemic stroke occurring despite anticoagulation, including the proposed AF-BREACH framework. It addresses an increasingly recognized clinical problem for which definitions, investigations, and management strategies remain poorly standardized. https://www.bmj.com/content/394/bmj-2025-084905 
• A comprehensive Pharmacological Reviews article on thrombin generation and the pharmacodynamics of parenteral anticoagulants. This review integrates anticoagulant pharmacology with effects on thrombin generation, providing a mechanistic framework for interpreting anticoagulant intensity, laboratory findings, and differences among parenteral anticoagulant therapies. https://pharmrev.aspetjournals.org/article/S0031-6997(26)00023-2/abstract 
• Perioperative antithrombotic management in thrombotic antiphospholipid syndrome. As senior author, Dr. Shaw led this study examining perioperative management strategies and clinical outcomes in patients with thrombotic antiphospholipid syndrome. It provides clinically relevant evidence for a high-risk population that has been largely absent from prospective perioperative anticoagulation studies. https://ashpublications.org/bloodadvances/article/10/9/3218/567207/Perioperative-management-of-antithrombotic-therapy 

Dr. Shaw is Co-Chair of the ISTH Scientific and Standardization Committee on Perioperative and Critical Care Thrombosis and Hemostasis, past Chair of CanVECTOR’s National Seminars Committee, and Associate Editor for Coagulation and Anticoagulant Drugs at European Heart Journal – Cardiovascular Pharmacotherapy. His work has been recognized with the Canadian Hematology Society Early Career Award, the Journal of Thrombosis and Haemostasis Editor’s Award and Top Peer Reviewer Award, and the Canadian Hematology Society's John H. Crookston Award.