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Full NameDr Dominick J H McCabe
Department:Vascular Neurology Research Foundation, Dept. of Neurology
Organisation:Trinity College Dublin
- neuroscience and mental health
Other Research Fields:
Translational platelet science / haemostasis in cerebrovascular disease in an overall TIA and ischaemic stroke patient population, Translational platelet science / haemostasis in patients with asymptomatic and symptomatic carotid stenosis, Antiplatelet therapy in TIA or ischaemic stroke, Whole blood flow cytometry, Ex vivo monitoring of ‘High on-Treatment Platelet Reactivity’ (HTPR), Endothelial activation, Transcranial Doppler ultrasound
Postgrad Medical Specialties
- Clinical Trials
- Geriatric Medicine
- Vascular Medicine
Dr McCabe initially trained in Neurology in Dublin, and subsequently completed clinical and academic training at the Institute of Neurology (ION) / The National Hospital for Neurology and Neurosurgery, Queen Square, and the Royal Free Hospital in London, U.K. He was initially appointed as Clinical Senior Lecturer and Honorary Consultant Neurologist at the Department of Clinical Neurosciences, Royal Free Campus, UCL-ION in 2004. He took up his current post as a Consultant Neurologist / Clinical Associate Professor in Neurology (TCD) at the Dept. of Neurology / Stroke Service, AMNCH in 2006 where he established and co-directs the ‘Daily, One-Stop Rapid Access Stroke Prevention Service’, and chairs the Neurovascular MDT at AMNCH. He has been instrumental in developing Clinical and Academic Neurology at AMNCH / TCD.
Dr McCabe is Chairperson of the Vascular Neurology Research Foundation (VNRF), Department of Neurology, AMNCH / TCD. His research group at AMNCH has an international reputation for conducting and publishing world-class research on translational platelet science, haemostasis and thrombosis, and vascular imaging in patients with ischaemic cerebrovascular disease (CVD) and asymptomatic and symptomatic carotid stenosis.
He has successfully supervised 3 PhDs in Clinical Neurosciences at TCD, was the supervising Vascular Neurologist for a HRB-funded Physiotherapy Fellow/PhD student at UCD, and is currently supervising further PhD and MSc students at AMNCH-TCD. He also successfully supervised a HRB-funded undergraduate student, and numerous NCHDs in health services research & audit projects. His group are currently participating in 16 local, national or international collaborative studies (see below). The VNRF has well established collaborative links with Prof James O’Donnell (Haemostasis Research Group, St James’s Hospital, TCD and The Irish Centre for Vascular Biology, RCSI), Dr Dermot Cox and Prof Niamh Moran (Dept of Molecular and Cellular Therapeutics, RCSI), and several other national and international collaborators in Ireland, The UK, Europe, North America and Australia.
Dr McCabe serves on several advisory groups including his roles as the Regional Stroke Neurology Lead, HSE Dublin Mid-Leinster Region / Dublin Midlands, Treasurer of the ‘Irish Heart Council on Stroke’, Committee member of the National Clinical Advisory Group for Stroke and National Stroke Audit Committee, and is Network Executive Committee Member and Lead Investigator, HRB-Stroke Clinical Trials Network, Ireland. He is a member of the recently-established, collaborative ‘Irish Centre for Vascular Biology’.
The main objective of the research carried out by Dr McCabe’s team at the VNRF, Dept. of Neurology, AMNCH / TCD is to improve our understanding of the potential pathophysiological mechanisms causing TIA or stroke, and to identify individuals who should benefit from a modified, ‘personalised’ anti-thrombotic therapy regimen to optimise their response to commonly-prescribed preventive treatments following TIA or stroke.
We are assessing FBC parameters, platelet function / reactivity, platelet activation, endothelial activation and coagulation system potential ex vivo in patients who are starting or changing antiplatelet therapy following TIA or ischaemic stroke with a comprehensive suite of assays on site in the Meath Foundation Research Laboratory at AMNCH.
We are also conducting case – case/control and nested longitudinal studies of FBC parameters, platelet function / reactivity, platelet activation, endothelial activation and coagulation system potential in patients with asymptomatic and recently symptomatic moderate to severe (≥50-99%) carotid stenosis.
We have a robust, growing international reputation for conducting research on Transcranial Doppler ultrasound monitoring for the detection of micro-embolic signals (MES) in patients with carotid stenosis, and for assessing the relationship between MES and platelet, endothelial and coagulation system biomarkers.
Selected recent references from peer-reviewed papers:
• Tobin WO, Kinsella JA, Collins DR, Coughlan T, O’Neill D MD, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJH. Enhanced ex-vivo inhibition of platelet function following addition of dipyridamole to aspirin after TIA or ischaemic stroke: First results from the TRinity AntiPlatelet responsiveness (TRAP) study. Br J Haematol 2011; 152: 640-647.
• Tobin WO, Kinsella JA, Coughlan T, Collins DR, O’Neill D, Murphy RP, Egan B, Tierney S, Feeley TM, McCabe DJH. High on-treatment platelet reactivity on commonly prescribed antiplatelet agents following TIA or ischaemic stroke: Results from the TRinity AntiPlatelet responsiveness (TRAP) study. Eur J Neurol 2013; 20: 344-52.
• Tobin WO, Kinsella JA, Kavanagh GF, O’Donnell JS, McGrath RA, Collins DR, Coughlan T, O’Neill D, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJH. Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischemic stroke. J Neurol 2013; 260: 590-596.
• Kinsella JA, Tobin WO, Hamilton G, McCabe DJH. Platelet activation, function and reactivity in atherosclerotic carotid artery stenosis: A systematic review of the literature. Int J Stroke 2013; 8: 451-464.
• Kinsella JA, Tobin WO, Tierney S, Feeley TM, Egan B, Collins DR, Coughlan T,
O’Neill D, Harbison JA, Madhavan P, Moore DJ, O’Neill SM, Colgan MP, Doherty CP, Murphy RP, Saqqur M, Moran N, Hamilton G, McCabe DJH. Increased platelet count and lymphocyte-platelet complexes in early symptomatic compared with asymptomatic moderate or severe carotid stenosis and relationship with microembolic status– results from the Platelets And Carotid Stenosis (PACS) study. J Thromb Haemostasis 2013; 11: 1407-1416.
• Kinsella JA, Tobin WO, Cox D, Coughlan T, Collins DR, O’Neill D, Murphy RP, McCabe DJH. Prevalence of ex vivo ‘high on-treatment platelet reactivity’ on antiplatelet therapy following TIA or ischaemic stroke on the PFA-100® and VerifyNow®. J Stroke Cerebrovasc Dis 2013; e84-92.
• Kinsella JA, Tobin WO, Kavanagh GF, O’Donnell JS, McGrath RT, Tierney S, Feeley TM, Egan B, O’Neill D, Collins DR, Coughlan T, Harbison JA, Doherty CP, Madhavan P, Moore DJ, O’Neill SM, Colgan MP, Saqqur M, Murphy RP, Moran N, Hamilton G, McCabe DJH. Increased endothelial activation in recently symptomatic versus asymptomatic carotid artery stenosis and in cerebral microembolic signal- negative patient subgroups. Eur J Neurol 2014; 21: 969-e55
• Tobin WO, Kinsella JA, Kavanagh GF, O’Donnell JS, McGrath RT, Coughlan T, Collins DR, O’Neill D, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJH. Longitudinal assessment of von Willebrand factor and von Willebrand factor propeptide in response to alteration of antiplatelet therapy after TIA or ischaemic stroke. J Neurol 2014; 261: 1405-12.
• Kinsella JA, Tobin WO, Kavanagh GF, O’Donnell JS, McGrath RT, Tierney S, Feeley TM, Egan B, O’Neill D, Collins DR, Coughlan T, Harbison JA, Doherty CP, Madhavan P, Moore DJ, O’Neill SM, Colgan MP, Saqqur M, Murphy RP, Moran N, Hamilton G, McCabe DJH. Increased thrombin generation potential in symptomatic versus asymptomatic moderate or severe carotid stenosis and relationship with cerebral microemboli. J Neurol Neurosurg Psychiatry 2015; 86: 460-467.
• McCabe DJH, Murphy SJX, Starke R, Harrison P, Brown MM, Sidhu PS, Mackie IJ, Scully M, Machin SJ. Relationship between ADAMTS13 activity, von Willebrand factor-antigen levels, and platelet function in the early phase after TIA or ischaemic stroke. J Neurol Sci 2015 348: 35-40.
• Lim ST, Coughlan CA, Murphy SJ, Fernandez-Cadenas I, Montaner J, Thijs V, Marquardt L, McCabe DJ. Platelet function testing in transient ischaemic attack and ischaemic stroke: A comprehensive systematic review of the literature. Platelets 2015; 26: 402 - 412.
• Murphy SJX, Coughlan CA, Tobin WO, Kinsella JA, Lonergan R, Gutkin M, McCabe DJH. Continuation and adherence rates on initially-prescribed intensive secondary prevention therapy after Rapid Access Stroke Prevention (RASP) service assessment. J Neurol Sci 2016; 361: 13-18.
• Tobin WO, Kinsella JA, Kavanagh GF, O’Donnell JS, McGrath R, Tierney S, Egan B, Feeley TM, Coughlan T, Collins DR, O’Neill D, Murphy SJX, Lim SJ, Murphy RP, McCabe DJH. Profile of von Willebrand factor antigen and von Willebrand factor propeptide in an overall TIA and ischaemic stroke population and amongst subtypes. J Neurol Sci 2017; 375: 404-410.
• Kinsella JA, Tobin WO, Tierney S, Feeley TM, Egan B, Dooley C, Coughlan T, Collins DR, O’Neill D, Harbison JA, Doherty CP, Madhavan P, Moore DJ, O’Neill SM, Colgan M-P, Saqqur M, Murphy RP, Moran N, Hamilton G, McCabe DJH. Assessment of ‘on-treatment platelet reactivity’ and relationship with cerebral microembolic signals in asymptomatic and symptomatic carotid stenosis. J Neurol Sci 2017; 376: 133-139.
• Lim ST, Murphy SJX, Smith DR, Williams J, Gil Navarro S, McCabe J, Moore DP, McHugh J, McCabe DJH. Long-term outcome in TIA or ischaemic stroke patients with a patent foramen ovale +/- an inter-atrial septal aneurysm in conjunction with comprehensive arterial and venous thrombophilia screening. J Neurol Sci 2017; 377: 227-233.
Title: The ongoing Optimal Antiplatelet Therapy in TIA and Ischaemic Stroke (OATS) Study
Summary: Platelets are excessively activated after transient ischaemic attacks (TIAs) or ischaemic stroke, and play a pivotal role in the formation of ‘blood clots’ that block arteries to cause a first or recurrent TIA or stroke.
The majority of patients with ischaemic cerebrovascular disease (CVD) are not protected from further vascular events with antiplatelet therapy. Aspirin is the most commonly prescribed antiplatelet drug for secondary prevention following TIA or ischaemic stroke, but the majority of patients are not protected from further vascular events with aspirin alone. Other antiplatelet therapies including aspirin-dipyridamole combination therapy or clopidogrel therapy may be superior to aspirin therapy on its own in individual patients. Patients with excessive platelet activation, or those who are deemed to be ‘poorly-responsive’ to antiplatelet agents on platelet function testing in the laboratory may have a higher risk of recurrent vascular events during long-term follow-up, or more severe strokes if they do experience a recurrence.
In this ongoing study, we are comprehensively assessing the impact of starting or changing antiplatelet therapy on platelet function, platelet activation, and endothelial activation in both the early (≤4 weeks) and late (≥ 3 months) phases after TIA or ischaemic stroke using novel and established laboratory tests. This study aims to identify ischaemic CVD patients who should benefit from modified, ‘personalised’ antiplatelet therapy to optimise their secondary prevention treatment regimen after TIA or stroke.
Suitable PhD candidates will coordinate aspects of the OATS study at AMNCH –TCD under the supervision of Dr McCabe and highly-experienced national and international collaborators, with a view to applying for funding for a pre-planned, multicentre international study, called the OATS-International (OATS-I) Study in which Dr McCabe will be the PI. There will also be an opportunity to collaborate in other translational studies in the department in patients with carotid stenosis.