Graeme Hankey

MD W.Aust., Clinical Professor

  • The University of Western Australia (M503), 35 Stirling Highway,

    6009 Perth

    Australia

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Personal profile

Biography

Professor Graeme J Hankey, MBBS, MD, FRCP, FRCPEdin, FRACP, FAHA, FESO, FWSO, FAHMS, is Professor of Neurology, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia;  Consultant Neurologist, Sir Charles Gairdner Hospital; Clinical Trials Advisor, the Harry Perkins Institute of Medical Research; and Research Affiliate, the Perron Institute for Neurological and Translational Science, Western Australia.

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.

Professor Hankey's main research interests include epidemiological studies and clinical trials of treatment strategies for acute stroke and stroke prevention.

Professor Hankey and colleagues have been awarded > $72 million in competitive research grants, including $9.5 million from international grants and $62 million from national grants ($58.7 million NHMRC, $4 million other)

He has authored or co-authored 1017 publications, including 13 books, 1 thesis, 4 booklets, 27 book chapters, 13 Guidelines, 667 original articles, 115 review articles, 71 editorials, 40 commentaries, 32 case reports and 34 letters to the editor.

His most recent books are:

- Gorelick PB, Testai FD, Hankey GJ, Wardlaw JM. Hankey’s Clinical Neurology. Third Edition, CRC Press, Taylor & Francis Group, 2021, Pages: 952, doi: 10.1201/9780429299476; Identifiers: LCCN 2020022754 (print) | LCCN 2020022755 (ebook) | ISBN 9780367280321 (paperback) | ISBN 9780367610876 (hardcover) | ISBN 9780429299476 (ebook);

- Saver JL, Hankey GJ. Stroke Prevention and Treatment: An Evidence-based Approach. Second Edition. Cambridge: Cambridge University Press. 2021, pages: 570; doi: 10.1017/9781316286234; Identifiers: LCCN 2019038966 (print) | LCCN 2019038967 (ebook) | ISBN 9781107113145 (hardback) | ISBN 9781316286234 (ebook).

- Hankey GJ, Macleod M, Gorelick PB, Chen C, Caprio F, Mattle H. Warlow's Stroke: Practical Management. Wiley Blackwell, 4th Edition, 2019 (1008 pages; ISBN 978 1 118 49222 2).

His publications have yielded

-  >262,000 citations (h index 163) according to Google Scholar and

-  >141,500 citations (h index 142) according to the Web of Science, Publons.

He has delivered > 570 invited lectures at international (n=342), national (n=132), and local (n=101) scientific meetings.

Professor Hankey was ranked 491 in the world among Highly Cited Researchers (h-index > 100) according to their Google Scholar Citations public profiles, by Ranking Web of Universities in 2022 <https://webometrics.info/en/hlargerthan100>.

Awards include:

1987:   Australian Association of Neurologists Overseas Training Fellowship (Mayo Clinic).

1987:   Bushell Travelling Fellowship in Medicine  of the Royal Australasian College of Physicians.               

1997:   Royal Society of Medicine Medical Book Award, Advanced Author Book Category, for “Stroke: A Practical Guide to Management”.     

1999:   Heart Foundation of Australia, President’s Award                              

2006:   Mervyn Eadie Lecture, Australian Association of Neurologists          

2006:   Western Australian Premier’s Award for Achievement in Science      

2008:   Australian of the Year nomination by Premier of Western Australia

2009:   Marjorie Robertson Lecture, Royal College of Physicians of Edinburgh.

2011:   Princess Margaret Memorial Lecture, UK Stroke Forum                    

2011:   Stroke Society of Australasia Excellence in Stroke Award                

2014:   Jamieson Medal, Neurosurgical Society of Australasia                    

2015:   American Stroke Association David G. Sherman Lecture Award for outstanding lifetime contributions in the field of stroke.                             

2015:   Wesfarmers’ Harry Perkins Medal. Wesfarmers Perkins Institute of Medical Research Oration. 

2016:   Top ranked National Health and Medical Research Council (NHMRC) program grant.

2017:   Web of Science Clarivate Analytics Highly Cited Researcher for ranking among the top 1% of researchers in the world for the most cited publications in the field of Clinical Medicine.

2018:   Web of Science Group, Clarivate Analytics Highly Cited Researcher for exceptional research performance demonstrated by production of multiple highly cited papers, those that rank in the top1% by citations for field and year, in Clinical Medicine. 

2019:   Web of Science Group, Clarivate Analytics Highly Cited Researcher in recognition of exceptional research performance demonstrated by production of multiple highly cited papers, those that rank in the top 1% by citations for field and year, in Cross-Field.

2020:      THE Awards, International Collaboration of the Year, Shortlist of Finalists: Mead G, Dennis M, Lundström E; Hankey G; Hackett M. The fluoxetine trilogy: an international collaboration between Scotland, England, Australia, New Zealand, Vietnam and Sweden. Universities of Edinburgh, Western Australia, New South Wales, Uppsala; and the Karolinksa Institutet Sweden. (https://www.the-awards.co.uk/2020/en/page/shortlist).

2021:      North Metropolitan Health Service, Going the Extra Mile (GEM) Awards, Researcher of the Year, Honourable Mention.

Roles and responsibilities

Editorial roles:

  • Associate Editor, Circulation
  • Editorial Consultant, The Lancet Neurology
  • Editorial consultant, Journal of American College of Cardiology : Advances
  • Section Co-Editor (Epidemiology, Outcomes & Population Science), Stroke
  • Senior Advisory Board Member, Cerebrovascular Diseases
  • Editorial board member:
  •   Cochrane Stroke Review Group
  •   Neuro-epidemiology
  •   Journal of Thrombosis and Thrombolysis
  • Past roles
    • Associate Editor (editor for Asia Pacific submissions), Stroke, 2000-2010;
    • Associate Editor, Stroke Treatment and Prevention, 2009-2016;
    • Consulting Editor, International Journal of Stroke;  2006-2021;
    • Editorial consultant, The Lancet; 2005-2015;                             
    • Editorial board member, Practical Neurology, 2000-2015.         
    • Section Editor, Neurovascular and Neurodegenerative diseases, JACC, 2014-2015.

Data Safety Monitoring  Boards:

Chair

  • Enhanced Control of Hypertension and Thrombectomy Stroke Study (ENCHANTED)-2 trial of blood pressure lowering in patients with acute ischaemic stroke with successful recanalization after mechanical thrombectomy. Principal investigator (PI). Prof. Craig S. Anderson.
  • ReCAPS trial: Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke Phase III RCT – PI. Prof. Dominique Cadilhac.
  • STARS trial: Safety and Tolerability of AZD6482 in Reperfusion for Stroke. PI. Prof. Chris Levi.

Member

  • TRIDENT trial. Triple therapy prevention of Recurrent Intracerebral Disease EveNts Trial. PIs: Craig Anderson, Clara Chow, John Chalmers.
  • PROTECT-U trial. A Prospective Randomized Open-label Trial to Evaluate risk faCTor management in patients with Unruptured intracranial aneurysms. PIs: Gabriel Rinkel, Ale Algra, Mervyn Vergouwen and Nima Etminan; The Netherlands and Germany.
  • STAREE trial. STAtins in Reducing Events in the Elderly (STAREE). PI. Prof Sophia Zoungas.
  • ACI-35-1802. A Phase Ib/IIa Multicenter, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate the Safety, Tolerability and Immunogenicity of Different Doses, Regimens and Combinations of Tau Targeted Vaccines in Subjects with Early Alzheimer’s Disease.
  • ETERNAL-LVO. Extending the time window for Tenecteplase by Effective Reperfusion of peNumbrAL tissue in patients with large vessel occlusion trial. PI: Prof. Mark Parsons.

Future research

Professor Hankey is presently:

Co-principal investigator of the:

  • ASPIRING trial. Antiplatelet Secondary Prevention International Randomised trial after INtracerebral HaemorrhaGe. PIs. Profs. Rustam Al-Shahi Salman, Craig Anderson, Graeme Hankey.

Steering committee member of the: 

  • AXIOMATIC-SSP phase II trial. Antithrombotic treatment with factor XIa inhibition to Optimize Management of Acute ThromboembolIC events for Secondary Stroke Prevention. PI. Prof. Mike Sharma.
  • RIBURST study. Reducing the International Burden of Stroke Using Mobile Technology and Stroke Riskometer app Study. PI. Prof. Valery Feigin;
  • PROMOTE trial. Polypill and RiskOMeter to prevent strOke and cogniTive impairment trial. PI. Prof. Sheila Martins;
  • CASPER trial. Colchicine After Stroke to Prevent Event Recurrence. PI Prof. Anthony Keech.
  • PACS study. Australian Paediatric Acute Code Stroke study. PI. Prof. Mark Mackay

A principal investigator of the

  • Health In Men Study (HIMS). PI. Prof. Paul Norman.

A member of the:

  • Global Burden of Disease Stroke Expert Panel;
  • Synergies TO Prevent Stroke (STOP stroke) advisory committee. PI. Prof. Seana Gall.

He is the chair of 3, and a member of 5, data safety monitoring committees of ongoing clinical trials.

Funding overview

Current research grants:

Hankey GJ.
Reducing the burden of stroke
NHMRC Practitioner Fellowship, Application ID: APP1137020
$577,188.50 for 5 years, 2018-2022.

Hankey GJ.                                                                                                      Research Excellence Award, Stream 2, Established Researcher, Western Australian Future Health Research and Innovation (FHRI) Fund, Goverment of Western Australia.                                                                                                 $110,000 for 2023, 2024

 

Previous positions

  • 1981-1987. Intern, RMO, Medical and Neurology registar, Royal Perth Hospital (RPH)
  • 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

Current projects

  • The Health in Men Study (HIMS).
  • Individual patient data meta-analysis of the AFFINITY, EFFECTS, and FOCUS trials of fluoxetine for recovery after stroke.
  • AXIOMATIC, global, phase 2 trial of adding an oral factor XIa inhibitor to clopidogrel and aspirin to prevent recurrent stroke in patients with acute TIA and mild ischaemic stroke.
  • The Reducing the International Burden of Stroke Using Mobile Technology (RIBURST) and Stroke Riskometer app Study.
  • The Global Burden of Disease Study
  • The Colchicine After Stroke to Prevent Event Recurrence (CASPER) trial (PI A. Keech; AI GJ Hankey)
  • Australian Paediatric Acute Code Stroke (PACS) study. (PI Mark Mackay; AI GJ Hankey)
  • Synergies TO Prevent Stroke: STOPstroke  (PI S. Gall)
  • Polypill and RiskOMeter to prevent strOke and cogniTive impairment (PROMOTE) trial (PI. Sheila Martins)

Teaching overview

Professor Hankey regularly teaches, examines and supervises undergraduate medical students and postgraduate medical, nursing and allied health colleagues.

Research

Professor Hankey was-

  • Principal investigator of the international VITAmins To Prevent Stroke [VITATOPS] trial;
  • Co-Principal investigator of the international Assessment of Fluoxetine for Stroke Recovery (AFFINITY) trial;
  • Steering committee member of the international CHARISMA, AMADEUS, BOREALIS, ROCKET-AF, NAVIGATE-ESUS, FOCUS and EFFECTS trials;
  • Australian national coordinator of the international IST, SPIRIT, ESPRIT, FOOD, IST-3 and NAVIGATE-ESUS trials;
  • Co-principal investigator of the Perth Community Stroke Study (PCSS) and Australian Co-operative Research on Subarachnoid Haemorrhage (ACROSS) studies;
  • A chief investigator of the Health in Men Study (HIMS);
  • Member of the Stroke Unit Trialists' Collaboration, Antithrombotic Trialists' Collaboration, INTERSTROKE study group, and Global Burden of Disease Stroke Expert Group
  • Co-chair, End Point Adjudication Committee, LoDoCo2 Trial

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);

Stroke Recovery

•Co-Principal investigator of the Assessment of Fluoxetine for Stroke Recovery (AFFINITY) trial in 1280 Vietnamese, Australian and New Zealand patients with recent stroke which showed that fluoxetine 20 mg given once daily for 6 months after acute stroke did not improve functional outcomes compared to placebo (Lancet Neurology 2020; 19:651-60). 

•Writing committee of the FOCUS trial in 3127 patients with recent stroke which showed that fluoxetine 20 mg given once daily for 6 months after acute stroke did not improve functional outcomes (Lancet 2019; 393: 265-274).

•Steering committee of the EFFECTS trial in 1500 Swedish patients with recent stroke which showed that fluoxetine 20 mg given once daily for 6 months after acute stroke did not improve functional outcomes compared to placebo (Lancet Neurology 2020; 19:661-69).

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).
• Steering Committee and Australian coordinator of the NAVIGATE ESUS trial which showed that rivaroxaban 15 mg once daily was not more effective than aspirin 100 mg once daily for preventing recurrent stroke in 7213 patients with recent Embolic Stroke of Undetermined Source (ESUS). N Engl J Med. 2018; 378: 2191-2201). 

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).

Anti-inflammatory therapy (low-dose colchicine) for the prevention of cardiovascular events

• Co-chair, End Point Adjudication Committee, LoDoCo2 Trial which showed that in 5522 patients with chronic coronary disease, low dose colchicine 0.5 mg daily reduced the risk of cardiovasculare events by about 30% compared to placebo (N Engl J Med 2020;383:1838-47)


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; Lancet 2016; 388: 761-75.; Lancet 2018; 391: 2019-2027)
• 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; https://www.dcn.ed.ac.uk/model/predict.htm).
• Co-author of description of lacunar transient ischaemic attacks (Lancet 1991; 337: 335-8).
• Member of the Global Burden of Disease Stroke Expert Panel which has quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level (Lancet Neurology. 2017;16: 877-897); and described global, regional, and national: age-sex specific mortality for 264 causes of death, 1980-2016 (Lancet. 2017; 390: 1151-1210); incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016 (Lancet. 2017; 390:1211-1259); disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016 (Lancet. 2017; 390: 1260-1344); and comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks, 1990-2016 (Lancet. 2017; 390:1345-1422).

Research expertise keywords

  • Neuroscience: stroke

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