ArticleBritish journal of haematology2017
Increased prevalence of potential right-to-left shunting in children with sickle cell anaemia and stroke.
Article in British journal of haematology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 40 citations in OpenAlex.
- Intracardiac or intrapulmonary shunts were present in at least 35% of adults with homozygous sickle cell disease followed in an outpatient clinic.Haematologica · 2019Trial
- Clinical, laboratory, radiological features, and outcome of acute fat embolism syndrome in sickle cell disease.Scientific reports · 2025Article
- Patent Foramen Ovale in Children: A Review of Recent Progress.Pediatric cardiology · 2025Review
- Prevalence of Antiplatelet and Anticoagulation Therapy in Children with Sickle Cell Anemia and Stroke.Pediatric stroke · 2025Article
- Cerebral fat embolism syndrome in a patient with homozygous sickle cell disease in the setting of multisystem inflammatory syndrome in children.Proceedings (Baylor University. Medical Center) · 2023Article
- Assessment of functional shunting in patients with sickle cell disease.Haematologica · 2022Article
- Spontaneous Pneumocephalus: An Incidental Finding With Prompt Resolution.The Neurohospitalist · 2022Article
- Individual Watershed Areas in Sickle Cell Anemia: An Arterial Spin Labeling Study.Frontiers in physiology · 2022Article
- Stroke and presence of patent foramen ovale in sickle cell disease.Journal of thrombosis and thrombolysis · 2021Review
- Epidemiology of Stroke in Sickle Cell Disease.Journal of clinical medicine · 2021Review
- Diverse manifestations of a sickle cell crisis.BMJ case reports · 2021Article
- Association Between Patent Foramen Ovale and Overt Ischemic Stroke in Children With Sickle Cell Disease.Frontiers in neurology · 2021Article
- Patent Foramen Ovale in Fetal Life, Infancy and Childhood.Medical sciences (Basel, Switzerland) · 2020Review
- Quantification of whole-brain oxygenation extraction fraction and cerebral metabolic rate of oxygen consumption in adults with sickle cell anemia using individual TMagnetic resonance in medicine · 2020Article
- Sleep-disordered breathing and comorbidities: role of the upper airway and craniofacial skeleton.Nature and science of sleep · 2020Review
- Identifying Clinical and Research Priorities in Sickle Cell Lung Disease. An Official American Thoracic Society Workshop Report.Annals of the American Thoracic Society · 2019Article
- Arteriopathy Influences Pediatric Ischemic Stroke Presentation, but Sickle Cell Disease Influences Stroke Management.Stroke · 2019Observational
- Cerebral microhemorrhages and cerebral fat embolism in hemoglobin S-C disease.Neurology. Clinical practice · 2019Article
- Review
- Vascular Instability and Neurological Morbidity in Sickle Cell Disease: An Integrative Framework.Frontiers in neurology · 2019Article
Corrections and comments
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Authors and funding
20 authors at 17 institutions in 2 countries.
Funding
Abstract
'Paradoxical' embolization via intracardiac or intrapulmonary right-to-left shunts (RLS) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (SCA), predispose to paradoxical embolization. We hypothesized that children with SCA and overt stroke (SCA + stroke) have an increased prevalence of potential RLS. We performed contrasted transthoracic echocardiograms on 147 children (aged 2-19 years) with SCA + stroke) mean age 12·7 ± 4·8 years, 54·4% male) and a control group without SCA or stroke (n = 123; mean age 12·1 ± 4·9 years, 53·3% male). RLS was defined as any potential RLS detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential RLS was significantly higher in the SCA+stroke group than controls (45·6% vs. 23·6%, P < 0·001). The odds ratio for potential RLS in the SCA + stroke group was 2·7 (95% confidence interval: 1·6-4·6) vs controls. In post hoc analyses, the SCA + stroke group had a higher prevalence of intrapulmonary (23·8% vs. 5·7%, P < 0·001) but not intracardiac shunting (21·8% vs. 18·7%, P = 0·533). SCA patients with potential RLS were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in SCA.
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Registered trials
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