03 November 2021
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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.

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. However, DIRECT-SAFE trial participants were given one of two treatment options.

“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 in Asian patients have far better outcomes than those with Direct where the association is not identified in Caucasian patients,” said Neurologist and Neurointerventionist, 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. The findings of DIRECT-SAFE will provide impetus that Bridging therapy should be offered to Asian stroke patients.

“This trial has changed the way strokes will be treated,” added Prof Yan.

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