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ESOC 2023 | Conducting randomized trials in rare stroke subtypes: insights from SECRET

Thalia Field, MD, FRCPC, MHSc, University of British Columbia in Vancouver, Canada, comments on the insights gained from the SECRET trial (NCT03178864) on conducting a randomized trial for a rare stroke subtype. As well as investigating the safety of rivaroxaban for anticoagulation in cerebral venous thrombosis (CVT), SECRET tested the feasibility of recruitment for a clinical trial in a rare stroke subtype. Given the rarity of the stroke subtype under investigation, the trial required collaboration to ensure an adequate sample size and robust results. Another important consideration is the proportion of patients who may be unwilling to participate in randomization. Patients, as well as their phyisicians, may have preconceptions about certain treatments meaning they do not want to undergo randomization. Dr Field acknowledges that certain patients may also be reluctant to take part due to their recent trauma. Approaching these patients later in their journey may mean they are more receptive to participating in a trial or registry.

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Thalia Field reports the following disclosures: Bayer Canada – in kind study medication; advisory board honoraria: Roche Canada, AstraZeneca, HLS Therapeutics; expert witness – Canadian medical protective association.