Professor Graeme Hankey
Medicine and Pharmacology, School of, QEII Medical Centre Unit
- Contact details
- School of Medicine and Pharmacology QEII Medical Centre Unit
The University of Western Australia (M503)
35 Stirling Highway
CRAWLEY WA 6009
- +61 8 6151 0828
- MD W.Aust.
- Professor Graeme J Hankey, MBBS, MD, FRCP, FRCPE, FRACP, FAHA, FESO is Professor of Neurology, School of Medicine and Pharmacology, The University of Western Australia; Consultant Neurologist, Sir Charles Gairdner Hospital, Perth, Western Australia; Clinical Trials Advisor, Harry Perkins Institute of Medical Research, Western Australia; and Research Affiliate and Honorary Senior Research Fellow, Western Australian Neuroscience Research Institute.
He received his undergraduate medical training at the University of Western Australia, and trained in neurology at the Royal Perth Hospital, Australia; Mayo Clinic, USA; and Western General Hospital, Edinburgh, UK.
- Key research
- Professor Hankey's main research interests include epidemiological studies and clinical trials of treatment strategies for acute stroke and stroke prevention.
- He was the principal investigator of the international VITAmins To Prevent Stroke [VITATOPS] trial, a member of the executive steering committee of the international CHARISMA, AMADEUS, BOREALIS and ROCKET-AF trials, national Australian coordinator of the international IST, SPIRIT, ESPRIT, FOOD and IST-3 trials, co-principal investigator of the Perth Community Stroke Study (PCSS) and Australian Co-operative Research on Subarachnoid Haemorrhage (ACROSS) studies, principal investigator of the Health in Men Study (HIMS), and member of the Stroke Unit Trialists' Collaboration and Antithrombotic Trialists' Collaboration.
- The impact of Professor Hankey’s research on clinical practice and guidelines includes his roles as/in the:
- Treatments for acute stroke
- •Writing committee of the Stroke Unit Trialists’s Collaboration which established the role of organised stroke care in a multidisciplinary stroke unit (Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000197);
- •Steering Committee of the Australian Streptokinase Trial (JAMA 1996; 276: 961-6) and only randomised trial of intra-arterial thromboytic therapy in acute posterior circulation ischaemic stroke (Cerebrovasc Dis 2005; 20: 12-17), and national Australian coordinator of the International Stroke Trial-3 (Lancet 2012; 379: 2352-63) which contributed to establishing the role of thrombolysis for acute ischaemic stroke;
- •Australian coordinator of the International Stroke Trial in 19,485 patients with acute ischaemic stroke, which established the role of aspirin as the initial treatment in acute ischaemic stroke to prevent early recurrent stroke (Lancet 1997; 349: 1569-81);
- •Data Safety and Monitoring Committee of the Intensive Blood Pressure Reduction for Acute Cerebral Haemorrhage Trial (INTERACT) trial which established the role of blood pressure-lowering in acute haemorrhagic stroke (Lancet Neurology 2008; 7: 391-9; N Engl J Med. 2013; 368: 2355-65);
- •Australian coordinator of the Feed Or Ordinary Diet (FOOD) trial which did not support a policy of routine oral supplementation after stroke (Lancet 2005; 365: 764-72) or early initiation of PEG feeding in dysphagic stroke patients (Lancet 2005; 365: 755-63);
- •Co-principal investigator of one of the first randomized controlled trials of a behavioural intervention for dysphagia after acute stroke which showed a consistent trend towards more favourable outcomes in patients assigned a standard programme of early behavioural swallowing intervention (Lancet Neurology 2006; 5: 31-37);
- Anticoagulation for the prevention of cardioembolic ischemic stroke
- •Executive Steering committee of the ROCKET‐AF trial which established the role of rivaroxaban as an alternative anticoagulant to warfarin in preventing stroke among 14,264 patients with atrial fibrillation (N Engl J Med 2011; 365: 883-91);
- •Outcome event adjudication committee of the RE-LY trial which established the efficacy of dabagatran etexilate compared with warfarin in patients with atrial fibrillation (N Engl J Med. 2009; 361: 1139-51).
- •Outcome event adjudication committee of the AVERROES trial which established the efficacy and safety of apixaban vs acetylsalicylic acid for preventing stroke in atrial fibrillation patients who have failed or are unsuitable for Vitamin K antagonist treatment (N Engl J Med. 2011; 364: 806-17.)
- •Steering Committee of the AMADEUS trial which showed that long-term treatment with idraparinux was no worse than vitamin K antagonists in terms of efficacy, but caused significantly more bleeding, in 4,576 patients with atrial fibrillation at risk for thromboembolism [Lancet 2008; 371: 315-321).
- •Steering Committee of the BOREALIS-AF trial (EFC10295) of subcutaneous biotinylated idraparinux (SSR126517E) with adjusted-dose warfarin in 3,773 patients with atrial fibrillation (J Thromb Haemost. 2014; 12: 824-30);
- •Stroke Advisory & Adjudication Committee of the ACTIVE trials which showed that clopidogrel plus aspirin was not as effective as oral anticoagulation (Lancet 2006; 367: 1903-12.) but was more effective than aspirin for preventing stroke in patients with atrial fibrillation (N Engl J Med 2009; 360: 2066-78);
- Antiplatelet therapy for the prevention of arterial ischemic stroke
- •Antiplatelet and Antithrombotic Trialists’ Collaboration member, which confirmed the effectiveness of antiplatelet therapies for preventing recurrent vascular events in high vascular risk patients, including those with ischaemic stroke and TIA (BMJ 1994; 308: 81-106, BMJ 2002; 324: 71-86);
- •Steering Committee and Australian coordinator of the European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) which established the superiority of the combination of aspirin and extended-release dipyridamole compared to aspirin in 2,739 patients with ischaemic stroke of arterial origin (Lancet 2006; 367: 1665-73), and that anticoagulation is not as effective as antiplatelet therapy for ischaemic stroke of arterial origin (Lancet Neurol 2007; 6: 115-24);
- •Investigator in the CAPRIE trial which established the superiority of clopidogrel compared to aspirin in preventing recurrent vascular events among patients with ischaemic stroke of arterial origin (Lancet 1996; 348: 1333-8);
- •Steering Committee of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial which showed that long-term clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing the rate of major vascular events in 15,603 patients with symptomatic atherothrombosis and patients with multiple risk factors [N Engl J Med 2006; 354: 1706-17);
- •Steering Committee of the Aortic arch Related Cerebral Hazard (ARCH) trial which reported that patients with an ischemic stroke and aortic arch plaques ≥4 mm treated with clopidogrel plus aspirin had a significant reduction in vascular death compared with patients allocated warfarin (Stroke 2014; 45:1248-57).
- •Australian coordinator for the Stroke Prevention in Reversible Ischaemia Trial (SPIRIT), which established that anticoagulantion with an INR range of 3.0 to 4.5 in patients after cerebral ischemia of presumed arterial origin is not safe (Ann Neurol 1997, 42: 857-865),
- •Steering Committee and Australian coordinator for Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2P – TIMI 50) trial which showed that inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy but it increased the risk of moderate or severe bleeding (N Engl J Med. 2012; 366: 1404-13; Stroke. 2013; 44: 691-8).
- Lipid-lowering therapy for the prevention of arterial ischemic stroke
- •Stroke Outcome Events Adjudication Committee of the Long‐term Intervention with Pravastatin in Ischaemic Disease (LIPID) trial which contributed to establishing the role of cholesterol‐lowering by statins to prevent stroke (N Engl J Med 2000; 343: 317-326);
- Carotid revascularisation for the prevention of arterial ischemic stroke
- •Investigator in the ESCT and NASCET trials which established the role of carotid endarterectomy in the prevention of stroke among patients with recent carotid territory ischaemia due to severe ipsilateral carotid artery stenosis (Lancet 1998; 351: 1379-1387; N Engl J Med 1998; 339: 1415-25);
- •Investigator in the CAVATAS trial which contributed to establishing the role of carotid artery stenting in the prevention of stroke among patients with recent carotid territory ischaemia due to severe ipsilateral carotid artery stenosis (Lancet 2001; 357: 1729-1737);
- B-vitamins for the prevention of recurrent stroke
- •Principal investigator of the VITAmins TO Prevent Stroke (VITATOPS) trial which showed that daily administration of folic acid, vitamin B6, and vitamin B12 to 8,164 patients with recent stroke or transient ischaemic attack was safe but not more effective than placebo in reducing the incidence of major vascular events (Lancet Neurology 2010; 9: 855-65);
- Epidemiology of stroke
- •Co-principal investigator of the Perth Community Stroke Study (PCSS) which was the first large community based study of the incidence and outcome of stroke in Australia, and the first to show that the incidence of stroke in the community of Perth, Australia declined by 40% between 1990 and 2000 (Stroke 2008; 39: 776-82);
- •Co-principal investigator of the Australian Co-operative Research on Subarachnoid Haemorrhage (ACROSS) study which was the first large community based study of the incidence, triggers and outcome of subarachnoid haemorrhage in Australia (Stroke 2003; 34: 1771-1776);
- •Co-principal investigator of the Health in Men Study (HIMS) which is one of the large cohorts studies of the incidence and predictors of multiple health outcomes, including stroke, among elderly Australian men (Int J Epidemiol 2009; 38: 48-52; Stroke. 2011; 42: 952-9)
- •National Australian coordinator of the INTERSTROKE study which showed that ten risk factors are associated with 90% of the risk of stroke, suggesting that targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the global burden of stroke ( Lancet 2010; 376: 112-23.)
- •Co-author of the Hankey score for predicting future vascular events among patients with transient ischaemic attacks (JNNP 1992; 56: 752-9; BMJ 1993; 306: 1107-11; Stroke 2010; 41: 487-493; http://www.dcn.ed.ac.uk/model/predict.htm).
- •Co-author of description of lacunar transient ischaemic attacks (Lancet 1991; 337: 335-8).
- Professor Hankey has authored or co-authored more than 720 peer-reviewed articles published in medical journals such as the New England Journal of Medicine (n=11), Lancet (41), Lancet Neurology (27), and Stroke (75).
His publications have >52,500 citations and his H-index is 96 (96 publications with > 96 citations) according to Google Scholar. His publications have >33,000 citations and his H-index is 81 according to the Web of Science, Thomson Reuters.
He is the author or co-author of 10 books (the most recent Hankey’s Clinical Neurology, 2nd edition, 2014), 20 book chapters and 12 Guidelines on aspects of stroke and clinical neurology.
- Roles, responsibilities and expertise
- Professor Hankey is an editorial consultant for The Lancet and The Lancet Neurology, consulting editor for the International Journal of Stroke, associate editor of Stroke Treatment and Prevention, Section Editor (Neurovascular and Neurodegenerative Diseases) of the Journal of the American College of Cardiology (JACC), and member of the editorial boards of Stroke, the Cochrane Stroke Review Group, Cerebrovascular Diseases, Practical Neurology, Neuro-epidemiology, and International Review of Thrombosis. He was associate editor (editor for all submissions from the Asia Pacific region) of Stroke, journal of the American Stroke Association, from 2000-2010.
- Future research
- Professor Hankey is presently co-principal investigator of the Assessment oF FluoxetINe In sTroke RecoverY (AFFINITY) trial in Australia and New Zealand, Executive and Steering Committee member of the PARFAIT (PAR-4 Antagonist for Ischemic stroke and TIA) trial, Steering committee member of the Fluoxetine Or Control Under Supervision trial (FOCUS) in the United Kingdom and the Efficacy of Fluoxetine- a randomised controlled trial in stroke (EFFECTS) in Sweden, and national coordinator for Australia and steering committee member of the international NAVIGATE-ESUS trial of rivaroxaban vs aspirin in patients with recent Embolic Stroke of Undetermined Source (ESUS).
- Funding received
- Professor Hankey and his colleagues have been awarded $70 million in competitive research grants, including $9.4 million from international grants, $59 million from national grants ($56.4 million NHMRC, $2.6 million other), and $1.6 million from local grants.
He currently holds an NHMRC program grant and project grant as outlined below:
Donnan GA, Davis SM, Hankey GJ, Howells D, Parsons M.
Improving stroke outcomes: attenuating progression and recurrence.
NHMRC Program Grant, Application ID: 1013612.
$ 8,707,355 for 5 years (2012-2016)
Hankey GJ, Hackett M, Almeida O, Flicker L, Mead G, Dennis MS, Etherton-Beer C, Ford A, Billot L, Jan S.
Assessment oF FluoxetINe In sTroke recoverY (AFFINITY)
NHMRC Project Grant, Application: APP1059094
$2,212,237.40 for five years
$620,377.30 for 2014
$570,377.80 for 2015
$435,377.30 for 2016
$320,265.50 for 2017
$265,840.00 for 2018
Davis SM, Donnan GA, Hankey GJ, Parsons M, Levi C, Campbell B
Saving brain and changing practice in stroke.
NHMRC Program Grant, Application ID: 1113352.
$ 13,787,375.00 for 5 years (2017-2021).
The NHMRC program grant for 2017-2021 was the top ranked NHMRC Program Grant application for the year.
Additional current funding include:
Mead G, Dennis M, House A, Forbes J, MacLeod M, Lewis S, Hankey G, Hackett M, Anderson C, Morales D, Sullivan F.
Fluoxetine of control Under Supervision (FOCUS). A multicentre randomised trial to establish the effect(s) or routine administration of Fluoxetine in patients with a recent stroke.
United Kingdom National Institute for Health Research Technology (NIHR) Health Technology Assessment Programme (HTA), HTA Project 13/04/30
UK £ 2,088,148 for 54 months; October 1, 2014 - March 31, 2019
Murray V, Norvving B, Wester P, Dennis M, Mead G, Hankey G, Hackett M, Mårtensson B, Castrén E, Wallén H, Lundström E. EFFECTS – a Swedish multicentre randomised placebo-controlled trial to establish the efficacy of fluoxetine in patients with a recent stroke.
Vetenskapsrådet (The Swedish Research Council), 921-2014-7072
SEK (Swedish Krona) 31,114,000 = Aus $ 5 million
January 1, 2015 to 31 December 2017
- Professor Hankey is a Fellow of the American Heart Association, Fellow of the European Stroke Association, and a member of numerous professional associations, including the Board of the World Stroke Organisation, Scientific Council of the American Stroke Association, and the Association of British Neurologists. He was a Director and Councillor of the Australian Association of Neurologists between 2004 and 2007. He was a member of the NHMRC Health Care Committee 2013-2015.
- Honours and awards
- Professor Hankey has been awarded the:
2015 American Stroke Association David G. Sherman lecture award for outstanding lifetime contributions to the field of stroke,
2015 Wesfarmers’ Harry Perkins Medal 2015 from the Harry Perkins Institute of Medical Research,
2014 Neurosurgical Society of Australasia Jamieson Medal,
2011 Stroke Society of Australasia Excellence in Stroke Award,
2011 UK Stroke Forum Princess Margaret Memorial Lecture,
2009 Royal College of Physicians of Edinburgh Marjorie Robertson Lecture,
2006 Western Australian Premier’s prize for achievement in science,
2006 Australian Association Neurologists Mervyn Eadie award for career achievement in neuroscience research,
1999 National Heart Foundation President’s Award,
1997 Royal Society of Medicine Medical Book Award - Advanced Author Book category - for Stroke: A Practical Guide to Management (Blackwell Scientific Publications, Oxford),
1987 Royal Australasian College of Physicians Bushell Travelling Fellowship in Medicine or the Allied Sciences, and
1987 Australian Association of Neurologists Overseas Training Fellowship for the Mayo Clinic, USA.
The NHMRC program grant for 2017-2021 was the top ranked NHMRC Program Grant application for the year (Davis SM, Donnan GA, Hankey GJ, Parsons M, Levi C, Campbell B. Saving brain and changing practice in stroke. NHMRC Program Grant ID: 1113352)
- Previous positions
- 1981-1987. Intern, RMO, Medical and Neurology registar, Royal Perth Hospital
1988.Senior Clinical Fellow in Neurology, Mayo Clinic, Rochester, Minnesota, USA
1989-1992. Research Fellow, Dept. of Clinical Neurosciences, University of Edinburgh,
Western General Hospital, Edinburgh, Scotland, UK (Supervisor Prof. CP Warlow)
1992-2013. Consultant Neurologist, RPH
1998-2013, Head of Stroke Unit,RPH
- Professor Hankey has delivered 535 invited lectures at international (n=310), national (n=129), and local (n=96) scientific meetings.
He regularly teaches undergraduate medical students and postgraduate medical, nursing and allied health colleagues.
- Current external positions
- Editorial Consultant, The Lancet
Editorial Consultant, The Lancet Neurology
Consulting Editor, International Journal of Stroke (World Stroke Organisation)
Section Editor, Neurovascular and Neurodegenerative Diseases, Journal of the American College of Cardiology (JACC)
Member, editorial boards of Stroke (journal of the American Stroke Association), the Cochrane Stroke Review Group, Cerebrovascular Diseases, International Journal of Stroke, Practical Neurology, Neuro-epidemiology, International Review of Thrombosis, Cerebrovascular Disease Foreign Medical Sciences, and China Journal of Stroke.
Chair, Data Safety Monitoring Committee, ATTEND trial of Family-Led RehabiliTaTion after stroke in INDia.
Chair, Data Safety Monitoring Board, ACI-24: Efficacy and safety of ACI-24 in patients with mild to moderate Alzheimer’s Disease: A phase I/II double-blind, randomised, placebo-controlled, adaptive design trial. ACI-24-0701, Eudra CT number 2008-006257-40. AC Immune, Lausanne, Switzerland.
Chair, ACI-35-1201A Phase I Double-Blind, Randomized, Placebo-Controlled Study of the Safety, Tolerability and Immunogenicity of ACI-35 in Patients with Mild to Moderate Alzheimer’s Disease. EudraCT Number 2013-000803-18. AC Immune. Lausanne, Switzerland.
Member, Data Safety Monitoring Board, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). An international quasi-factorial randomized comparative clinical trial of low versus standard-dose rtPA and intensive versus guideline-recommended blood pressure control in patients with ischaemic stroke who are eligible for thrombolysis.
Member, Data Safety Monitoring Board (DSMB) member of the STAtins in Reducing Events in the Elderly (STAREE) clinical trial.
Member, Global Burden of Disease Stroke Expert Panel (Chair Professor Valery Feigin)
Member, Board of Directors, World Stroke Organisation
Member, Publications Committee, World Federation of Neurology
- Current projects
- Health in Men Study (HIMS).
Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial: An Australasian, multi-centre, randomized, double-blind, placebo-controlled trial of the efficacy of fluoxetine in improving functional recovery after acute stroke.
Fluoxetine Or Control Under Supervision trial (FOCUS) in the United Kingdom.
Efficacy of Fluoxetine- a randomised controlled trial in stroke (EFFECTS) in Sweden.
The international NAVIGATE-ESUS trial of rivaroxaban vs aspirin in patients with recent Embolic Stroke of Undetermined Source (ESUS).
PARFAIT (PAR-4 Antagonist for Ischemic stroke and TIA) trial of PAR-4 antagonist antiplatelet therapy vs aspirin in acute ischaemic stroke and TIA
- Research profile
Research profile and publications