Evidence map›Paper›PMID 9647873›Full record

Trial reportThe New England journal of medicine1998

Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography.

R J Adams, V C McKie, L Hsu, B Files, E Vichinsky, C Pegelow, M Abboud, D Gallagher, A Kutlar, F T Nichols and 2 more

5 registry-linked trialsOpen access · bronzeAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 1998. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 550 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
550citing papers in PubMed, 5 pooled it
30.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT00000592 phase3completednot on this map

Stroke Prevention in Sickle Cell Anemia (STOP 1)

TypeinterventionalSponsorAugusta UniversityRan1994 to 2000ConditionsAnemia, Sickle Cell, Cerebral Embolism and Thrombosis, Cerebrovascular Disorders, Hematologic DiseasesArmsblood transfusion
NCT02561312 completednot on this mapstarted 2015, after this paper: background citation

Comparison of Two Methods of Transfusion for Stroke Prevention in Sickle Cell

TypeobservationalSponsorChattanooga-Hamilton County Hospital AuthorityRan2015 to 2017Enrolled9ConditionsAnemia, Sickle Cell, Sickling Disorder Due to Hemoglobin SArmsRapid manual partial exchange transfusion, Simple Transfusion
NCT04076683 nacompletednot on this mapstarted 2022, after this paper: background citation

Validation d'Une Stratégie de Programme Transfusionnel Par Erythraphérèse basée Sur un Algorithme d'Aide à la Prescription Transfusionnelle Chez Les Patients Adultes Drépanocytaires

TypeinterventionalSponsorEtablissement Français du SangRan2022 to 2023Enrolled65ConditionsSickle Cell DiseaseArmsAlgodrep
NCT05469828 phase1 / phase2not yet recruitingnot on this mapstarted 2024, after this paper: background citation

Crizanlizumab Improves Tissue Oxygen Supply Demand Matching in Patients With Sickle Cell Anemia

TypeinterventionalSponsorChildren's Hospital Los AngelesRan2024 to 2029Enrolled30ConditionsSickle Cell DiseaseArmsCrizanlizumab, control
NCT06526117 phase4recruitingnot on this mapstarted 2024, after this paper: background citation

Primary Prevention of Stroke in Children With SCD in Sub-Saharan Africa II: A Multicenter, Open-label, Single-arm Type I Hybrid Clinical Trial

TypeinterventionalSponsorVanderbilt University Medical CenterRan2024 to 2030Enrolled220ConditionsSickle Cell Disease, StrokeArmsHydroxyurea
3 · Its place in the literature

Who cites it

550 citing papers in PubMed, 5 syntheses or guidelines pooled it, 1,849 citations in OpenAlex.

  1. Guideline
  2. 4D flow MRI for non-invasive measurement of blood flow in the brain: A systematic review.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2021
    Pooled it
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  4. Hematopoietic stem cell transplantation for people with sickle cell disease.The Cochrane database of systematic reviews · 2020
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490 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 9 institutions in 1 country.

R J AdamsDepartment of Neurology, Medical College of Georgia, Augusta 30912-3200, USA.
V C McKie
L Hsu
B Files
E Vichinsky
C Pegelow
M Abboud
D Gallagher
A Kutlar
F T Nichols
D R Bonds
D Brambilla
Augusta University · USNew England Research Institutes · USAugusta University Health · USChildren’s Institute · USEast Carolina University · USEmory University · USMedical University of South Carolina · USNational Institutes of Health · USUniversity of Miami · US

Funding

STROKE PREVENTION TRIAL IN SICKLE CELL ANEMIA (STOP)U10HL052193 · NHLBI · MEDICAL COLLEGE OF GEORGIA (MCG) · PI ADAMS, ROBERT J · 1994 to 2000
$234k
STROKE PREVENTION TRIAL IN SICKLE CELL ANEMIAU10HL052016 · NHLBI · NEW ENGLAND RESEARCH INSTITUTES, INC. · PI BRAMBILLA, DONALD J · 1994 to 2000
$58k
NHLBI NIH HHS U10 HL 52016NHLBI NIH HHS U10 HL 52193
6 · The paper itself

Abstract

backgroundBlood transfusions prevent recurrent stroke in children with sickle cell anemia, but the value of transfusions in preventing a first stroke is unknown. We used transcranial Doppler ultrasonography to identify children with sickle cell anemia who were at high risk for stroke and then randomly assigned them to receive standard care or transfusions to prevent a first stroke.

methodsTo enter the study, children with sickle cell anemia and no history of stroke had to have undergone two transcranial Doppler studies that showed that the time-averaged mean blood-flow velocity in the internal carotid or middle cerebral artery was 200 cm per second or higher. The patients were randomly assigned to receive standard care or transfusions to reduce the hemoglobin S concentration to less than 30 percent of the total hemoglobin concentration. The incidence of stroke (cerebral infarction or intracranial hemorrhage) was compared between the two groups.

resultsA total of 130 children (mean [+/-SD] age, 8.3+/-3.3 years) were enrolled; 63 were randomly assigned to receive transfusions and 67 to receive standard care. At base line, the transfusion group had a slightly lower mean hemoglobin concentration (7.2 vs. 7.6 g per deciliter, P=0.001) and hematocrit (20.4 vs. 21.7 percent, P=0.002). Ten patients dropped out of the transfusion group, and two patients crossed over from the standard-care group to the transfusion group. There were 10 cerebral infarctions and 1 intracerebral hematoma in the standard-care group, as compared with 1 infarction in the transfusion group -- a 92 percent difference in the risk of stroke (P<0.001). This result led to the early termination of the trial.

conclusionsTransfusion greatly reduces the risk of a first stroke in children with sickle cell anemia who have abnormal results on transcranial Doppler ultrasonography.

Indexed as

Blood TransfusionAdolescentAnemia, Sickle CellBlood Flow VelocityCerebral HemorrhageCerebral InfarctionCerebrovascular CirculationCerebrovascular DisordersChildChild, PreschoolDisease-Free SurvivalFemaleHemoglobin, SickleHumansIncidenceMaleHemoglobin, Sickle

Identifiers

PMID9647873
OpenAlexW2314213298

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.