Cochrane · systematic review · CD003146
Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease
Estcourt, LJ, Kohli, R, Hopewell, S, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
19
No studies
6
Included studies
NR
No studies 6 · 21.4%Ungraded 3 · 10.7%Very low 13 · 46.4%Low 5 · 17.9%Moderate 1 · 3.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyLong‐term red cell transfusion versus no transfusion in people who are at risk of a primary stroke who have not had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who are at risk of a primary stroke who have not had previous long‐term red cell transfusions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs no transfusion | RR 0.12 [0.03, 0.49] | 2 studies · 326 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
All‐cause mortality Long‐term red cell transfusion vs no transfusion | no estimate extracted | 2 studies · 326 participants | Very low Downgraded: imprecision |
Adverse events associated with transfusion Long‐term red cell transfusion vs no transfusion | RR 3.16 [0.18, 57.17] | 1 study · 121 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
TIA Long‐term red cell transfusion vs no transfusion | Peto OR 0.13 [0.01, 2.11] | 2 studies · 323 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs no transfusion | RR 0.24 [0.12, 0.48] | 2 studies · 326 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Measures of neurological impairment Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 166 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Quality of life Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 196 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Long‐term red cell transfusion versus no transfusion in people who are at risk of a primary stroke who have had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who are at risk of a primary stroke who have had long‐term red cell transfusions to prevent a stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs no transfusion | RR 0.22 [0.01, 4.35] | 1 study · 79 participants | Very low Downgraded: risk of bias |
All‐cause mortality Long‐term red cell transfusion vs no transfusion | Peto OR 8 [0.16, 404.12] | 1 study · 79 participants | Very low Downgraded: risk of bias |
Adverse events associated with transfusion Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 79 participants | Ungraded |
TIA Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 79 participants | Ungraded |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 79 participants | Ungraded |
Measures of neurological impairment ‐ not reported Long‐term red cell transfusion vs no transfusion | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term red cell transfusion vs no transfusion | no estimate extracted | NR | No studies |
Long‐term red cell transfusion versus hydroxyurea and phlebotomy in people who are at risk of a primary stroke who have had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who are at risk of a primary stroke who have had long‐term red cell transfusions to prevent a stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 121 participants | Very low Downgraded: imprecision |
All‐cause mortality Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 121 participants | Very low Downgraded: imprecision |
Adverse events associated with transfusion Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 121 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Incidence of TIA Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 1.02 [0.21, 4.84] | 1 study · 121 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 2.03 [0.39, 10.69] | 1 study · 121 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Measures of neurological impairment ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |
Long‐term red cell transfusion versus hydroxyurea and phlebotomy in people who are at risk of a secondary stroke who have had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who have had a stroke who have had long‐term red cell transfusions to prevent another stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 14.78 [0.86, 253.66] | 1 study · 133 participants | Very low Downgraded: risk of bias |
All‐cause mortality Long‐term red cell transfusion vs hydroxyurea and phlebotomy | Peto OR 0.98 [0.06, 15.92] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Transfusion‐related adverse events ‐ Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 56 participants | Low Downgraded: risk of bias |
Incidence of TIA Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 0.66 [0.25, 1.74] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 0.33 [0.04, 3.08] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Measures of neurological impairment ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |
Long‐term red cell transfusion versus no transfusion in people who are at risk of a primary stroke who have not had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who are at risk of a primary stroke who have not had previous long‐term red cell transfusions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs no transfusion | RR 0.12 [0.03, 0.49] | 2 studies · 326 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
All‐cause mortality Long‐term red cell transfusion vs no transfusion | no estimate extracted | 2 studies · 326 participants | Very low Downgraded: imprecision |
Adverse events associated with transfusion Long‐term red cell transfusion vs no transfusion | RR 3.16 [0.18, 57.17] | 1 study · 121 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
TIA Long‐term red cell transfusion vs no transfusion | Peto OR 0.13 [0.01, 2.11] | 2 studies · 323 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs no transfusion | RR 0.24 [0.12, 0.48] | 2 studies · 326 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Measures of neurological impairment Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 166 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Quality of life Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 196 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Long‐term red cell transfusion versus no transfusion in people who are at risk of a primary stroke who have had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who are at risk of a primary stroke who have had long‐term red cell transfusions to prevent a stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs no transfusion | RR 0.22 [0.01, 4.35] | 1 study · 79 participants | Very low Downgraded: risk of bias |
All‐cause mortality Long‐term red cell transfusion vs no transfusion | Peto OR 8 [0.16, 404.12] | 1 study · 79 participants | Very low Downgraded: risk of bias |
Adverse events associated with transfusion Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 79 participants | Ungraded |
TIA Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 79 participants | Ungraded |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs no transfusion | no estimate extracted | 1 study · 79 participants | Ungraded |
Measures of neurological impairment ‐ not reported Long‐term red cell transfusion vs no transfusion | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term red cell transfusion vs no transfusion | no estimate extracted | NR | No studies |
Long‐term red cell transfusion versus hydroxyurea and phlebotomy in people who are at risk of a primary stroke who have had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who are at risk of a primary stroke who have had long‐term red cell transfusions to prevent a stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 121 participants | Very low Downgraded: imprecision |
All‐cause mortality Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 121 participants | Very low Downgraded: imprecision |
Adverse events associated with transfusion Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 121 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Incidence of TIA Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 1.02 [0.21, 4.84] | 1 study · 121 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 2.03 [0.39, 10.69] | 1 study · 121 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Measures of neurological impairment ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |
Long‐term red cell transfusion versus hydroxyurea and phlebotomy in people who are at risk of a secondary stroke who have had previous long‐term red cell transfusions
Population: individuals with sickle cell disease who have had a stroke who have had long‐term red cell transfusions to prevent another stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical stroke Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 14.78 [0.86, 253.66] | 1 study · 133 participants | Very low Downgraded: risk of bias |
All‐cause mortality Long‐term red cell transfusion vs hydroxyurea and phlebotomy | Peto OR 0.98 [0.06, 15.92] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Transfusion‐related adverse events ‐ Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | 1 study · 56 participants | Low Downgraded: risk of bias |
Incidence of TIA Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 0.66 [0.25, 1.74] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Serious adverse events as a result of sickle cell‐related complications Long‐term red cell transfusion vs hydroxyurea and phlebotomy | RR 0.33 [0.04, 3.08] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Measures of neurological impairment ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term red cell transfusion vs hydroxyurea and phlebotomy | no estimate extracted | NR | No studies |