DIRECT SAFE
20 July 2022
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An international, randomised controlled ischemic stroke trial DIRECT-SAFE suggests acute stroke treatment should be adapted based on ethnicity and race. 

Researchers from the Royal Melbourne Hospital (RMH) have looked at whether endovascular thrombectomy therapy should be accompanied by liquid clot buster, intravenous (IV) thrombolytic in acute stroke treatment.

Recently published in the Lancet, the study led by RMH Neurointerventionists’ Professor Peter Mitchell and Professor Bernard Yan, looked at patients across 25 sites in Australia and New Zealand, and China and Vietnam. Half of the participants were Caucasian and the other half were of Asian descent.

Prof Mitchell says the current gold standard to treat ischemic stroke patients is endovascular thrombectomy with bridging thrombolytic. However, a substantial proportion of patients in the world are not given concurrent intravenous thrombolytic, and the DIRECT-SAFE trial has been designed to resolve this uncertainty.

“The trial randomly assigned stroke patients to receiving either endovascular thrombectomy, which is a Direct therapy or endovascular thrombectomy with IV thrombolytics, which is a Bridging therapy,” said Prof Mitchell.

“It is of great interest that Bridging therapy confers improved benefits, and especially in Asian patients,” said Prof Yan.

“This is the first study in the world to strongly suggest that the response to acute stroke treatment is influenced by ethnicity and race. It has changed the way strokes will be treated and international guidelines amendments will follow,” added Prof Yan.

For patient Andrew Reynolds, he could not be more grateful for the treatment he received after suffering from a severe ischemic stroke.

After initially being treated at his local hospital with clot busting treatment, Andrew was transferred to the RMH where he underwent Endovascular thrombectomy - which removed the clot from the blocked brain arteries.

Within six hours he was able to move again and was discharged within 48 hours with no ongoing issues.

“You couldn’t fault the care I received, to be able to move my arm and leg again so quickly was a huge relief and I’m very grateful,” Andrew said.

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