Cochrane · systematic review · CD012389
Interventions for preventing silent cerebral infarcts in people with sickle cell disease
Estcourt, LJ, Kimber, C, 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
38
current version
GRADE rated
30
No studies
8
Included studies
NR
No studies 8 · 21.1%Ungraded 0 · 0%Very low 15 · 39.5%Low 14 · 36.8%Moderate 1 · 2.6%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 RBC transfusion compared to standard care for prevention of SCI in people with SCD and normal TCD velocities
Population: prevention of SCI in people with SCD and normal TCD velocities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Long‐term RBC transfusion vs standard care | RR 0.7 [0.23, 2.13] | 1 study · 196 participants | Low Downgraded: indirectness |
All‐cause mortality Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 196 participants | Low Downgraded: indirectness |
SCD ‐ related SAEs ‐ ACS Long‐term RBC transfusion vs standard care | RR 0.2 [0.08, 0.51] | 1 study · 196 participants | Low Downgraded: indirectness |
SCD‐related SAEs ‐ pain crisis Long‐term RBC transfusion vs standard care | RR 0.56 [0.4, 0.78] | 1 study · 196 participants | Low Downgraded: indirectness |
Clinical stroke Long‐term RBC transfusion vs standard care | RR 0.14 [0.02, 1.12] | 1 study · 196 participants | Low Downgraded: indirectness |
Cognitive function Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 196 participants | Low Downgraded: indirectness |
Quality of life Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 196 participants | Low Downgraded: indirectness |
Long‐term RBC transfusion compared to standard care for prevention of SCI in people with SCD and abnormal TCD velocities
Population: prevention of SCI in people with SCD and abnormal TCD velocities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Long‐term RBC transfusion vs standard care | RR 0.11 [0.02, 0.86] | 1 study · 124 participants | Low Downgraded: risk of bias |
All‐cause mortality Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 130 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
SCD ‐ related SAEs ‐ ACS Long‐term RBC transfusion vs standard care | RR 0.3 [0.11, 0.87] | 1 study · 130 participants | Low Downgraded: risk of bias, imprecision, indirectness |
SCD‐related SAEs ‐ pain crisis Long‐term RBC transfusion vs standard care | RR 0.9 [0.44, 1.86] | 1 study · 130 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Clinical stroke Long‐term RBC transfusion vs standard care | RR 0.1 [0.01, 0.73] | 1 study · 130 participants | Low Downgraded: risk of bias |
Cognitive function ‐ not reported Long‐term RBC transfusion vs standard care | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term RBC transfusion vs standard care | no estimate extracted | NR | No studies |
Long‐term RBC transfusions compared to standard care for SCD‐related SAEs and clinical stroke in people with SCD at risk of stroke and no previous long‐term RBC transfusions
Population: SCD‐related SAEs and clinical stroke in people with SCD at risk of stroke and no previous long‐term RBC transfusions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
SCD ‐ related SAEs ‐ ACS Long‐term RBC transfusions vs standard care | RR 0.24 [0.12, 0.49] | 2 studies · 326 participants | Low Downgraded: risk of bias, indirectness |
SCD‐related SAEs ‐ pain crisis Long‐term RBC transfusions vs standard care | RR 0.63 [0.42, 0.95] | 2 studies · 326 participants | Low Downgraded: risk of bias, indirectness |
Clinical stroke Long‐term RBC transfusions vs standard care | RR 0.12 [0.03, 0.49] | 2 studies · 326 participants | Moderate Downgraded: risk of bias, indirectness |
Transfusions continued compared to transfusions halted for prevention of SCI in people with SCD and normalised TCD velocities
Population: prevention of SCI in people with SCD and normalised TCD velocities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Transfusions continued vs transfusions halted | RR 0.29 [0.09, 0.97] | 1 study · 77 participants | Low Downgraded: risk of bias |
All‐cause mortality Transfusions continued vs transfusions halted | Peto OR 8 [0.16, 404.12] | 1 study · 79 participants | Very low Downgraded: risk of bias |
Clinical stroke Transfusions continued vs transfusions halted | RR 0.22 [0.01, 4.35] | 1 study · 79 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ ACS Transfusions continued vs transfusions halted | no estimate extracted | 1 study · 79 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ pain crisis Transfusions continued vs transfusions halted | no estimate extracted | 1 study · 79 participants | Very low Downgraded: risk of bias |
Cognitive function ‐ not reported Transfusions continued vs transfusions halted | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Transfusions continued vs transfusions halted | no estimate extracted | NR | No studies |
Hydroxyurea compared to RBC transfusions for prevention of SCI in people with SCD who have not had a stroke (primary prevention)
Population: prevention of SCI in people with SCD who have not had a stroke (primary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Hydroxyurea vs RBC transfusions | no estimate extracted | 1 study · 121 participants | Very low Downgraded: indirectness |
All‐cause mortality Hydroxyurea vs RBC transfusions | no estimate extracted | 1 study · 1 participants | Very low Downgraded: indirectness |
SCD‐related SAEs ‐ ACS Hydroxyurea vs RBC transfusions | RR 2.03 [0.39, 10.69] | 1 study · 121 participants | Very low Downgraded: indirectness |
SCD‐related SAEs ‐ pain crisis Hydroxyurea vs RBC transfusions | RR 5.08 [0.61, 42.23] | 1 study · 121 participants | Very low Downgraded: indirectness |
Clinical stroke Hydroxyurea vs RBC transfusions | no estimate extracted | 1 study · 121 participants | Very low Downgraded: indirectness |
Cognitive function ‐ not reported Hydroxyurea vs RBC transfusions | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Hydroxyurea vs RBC transfusions | no estimate extracted | NR | No studies |
Hydroxyurea compared to RBC transfusion for prevention of SCI in people with SCD who had a stroke (secondary prevention)
Population: prevention of SCI in people with SCD who had a stroke (secondary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Hydroxyurea vs RBC transfusion | Peto OR 7.28 [0.14, 366.91] | 1 study · 133 participants | Very low Downgraded: risk of bias |
All‐cause mortality Hydroxyurea vs RBC transfusion | OR 1.02 [0.06, 16.41] | 1 study · 133 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ ACS Hydroxyurea vs RBC transfusion | RR 0.33 [0.04, 3.08] | 1 study · 133 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ pain crisis Hydroxyurea vs RBC transfusion | RR 3.15 [1.23, 8.11] | 1 study · 133 participants | Low Downgraded: risk of bias |
Clinical stroke Hydroxyurea vs RBC transfusion | RR 14.78 [0.86, 253.66] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Cognitive function ‐ not reported Hydroxyurea vs RBC transfusion | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Hydroxyurea vs RBC transfusion | no estimate extracted | NR | No studies |
Long‐term RBC transfusion compared to standard care for prevention of SCI in people with SCD and normal TCD velocities
Population: prevention of SCI in people with SCD and normal TCD velocities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Long‐term RBC transfusion vs standard care | RR 0.7 [0.23, 2.13] | 1 study · 196 participants | Low Downgraded: indirectness |
All‐cause mortality Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 196 participants | Low Downgraded: indirectness |
SCD ‐ related SAEs ‐ ACS Long‐term RBC transfusion vs standard care | RR 0.2 [0.08, 0.51] | 1 study · 196 participants | Low Downgraded: indirectness |
SCD‐related SAEs ‐ pain crisis Long‐term RBC transfusion vs standard care | RR 0.56 [0.4, 0.78] | 1 study · 196 participants | Low Downgraded: indirectness |
Clinical stroke Long‐term RBC transfusion vs standard care | RR 0.14 [0.02, 1.12] | 1 study · 196 participants | Low Downgraded: indirectness |
Cognitive function Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 196 participants | Low Downgraded: indirectness |
Quality of life Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 196 participants | Low Downgraded: indirectness |
Long‐term RBC transfusion compared to standard care for prevention of SCI in people with SCD and abnormal TCD velocities
Population: prevention of SCI in people with SCD and abnormal TCD velocities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Long‐term RBC transfusion vs standard care | RR 0.11 [0.02, 0.86] | 1 study · 124 participants | Low Downgraded: risk of bias |
All‐cause mortality Long‐term RBC transfusion vs standard care | no estimate extracted | 1 study · 130 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
SCD ‐ related SAEs ‐ ACS Long‐term RBC transfusion vs standard care | RR 0.3 [0.11, 0.87] | 1 study · 130 participants | Low Downgraded: risk of bias, imprecision, indirectness |
SCD‐related SAEs ‐ pain crisis Long‐term RBC transfusion vs standard care | RR 0.9 [0.44, 1.86] | 1 study · 130 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Clinical stroke Long‐term RBC transfusion vs standard care | RR 0.1 [0.01, 0.73] | 1 study · 130 participants | Low Downgraded: risk of bias |
Cognitive function ‐ not reported Long‐term RBC transfusion vs standard care | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Long‐term RBC transfusion vs standard care | no estimate extracted | NR | No studies |
Long‐term RBC transfusions compared to standard care for SCD‐related SAEs and clinical stroke in people with SCD at risk of stroke and no previous long‐term RBC transfusions
Population: SCD‐related SAEs and clinical stroke in people with SCD at risk of stroke and no previous long‐term RBC transfusions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
SCD ‐ related SAEs ‐ ACS Long‐term RBC transfusions vs standard care | RR 0.24 [0.12, 0.49] | 2 studies · 326 participants | Low Downgraded: risk of bias, indirectness |
SCD‐related SAEs ‐ pain crisis Long‐term RBC transfusions vs standard care | RR 0.63 [0.42, 0.95] | 2 studies · 326 participants | Low Downgraded: risk of bias, indirectness |
Clinical stroke Long‐term RBC transfusions vs standard care | RR 0.12 [0.03, 0.49] | 2 studies · 326 participants | Moderate Downgraded: risk of bias, indirectness |
Transfusions continued compared to transfusions halted for prevention of SCI in people with SCD and normalised TCD velocities
Population: prevention of SCI in people with SCD and normalised TCD velocities
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Transfusions continued vs transfusions halted | RR 0.29 [0.09, 0.97] | 1 study · 77 participants | Low Downgraded: risk of bias |
All‐cause mortality Transfusions continued vs transfusions halted | Peto OR 8 [0.16, 404.12] | 1 study · 79 participants | Very low Downgraded: risk of bias |
Clinical stroke Transfusions continued vs transfusions halted | RR 0.22 [0.01, 4.35] | 1 study · 79 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ ACS Transfusions continued vs transfusions halted | no estimate extracted | 1 study · 79 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ pain crisis Transfusions continued vs transfusions halted | no estimate extracted | 1 study · 79 participants | Very low Downgraded: risk of bias |
Cognitive function ‐ not reported Transfusions continued vs transfusions halted | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Transfusions continued vs transfusions halted | no estimate extracted | NR | No studies |
Hydroxyurea compared to RBC transfusions for prevention of SCI in people with SCD who have not had a stroke (primary prevention)
Population: prevention of SCI in people with SCD who have not had a stroke (primary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Hydroxyurea vs RBC transfusions | no estimate extracted | 1 study · 121 participants | Very low Downgraded: indirectness |
All‐cause mortality Hydroxyurea vs RBC transfusions | no estimate extracted | 1 study · 1 participants | Very low Downgraded: indirectness |
SCD‐related SAEs ‐ ACS Hydroxyurea vs RBC transfusions | RR 2.03 [0.39, 10.69] | 1 study · 121 participants | Very low Downgraded: indirectness |
SCD‐related SAEs ‐ Pain crisis Hydroxyurea vs RBC transfusions | RR 5.08 [0.61, 42.23] | 1 study · 121 participants | Very low Downgraded: indirectness |
Clinical stroke Hydroxyurea vs RBC transfusions | no estimate extracted | 1 study · 121 participants | Very low Downgraded: indirectness |
Cognitive function ‐ not reported Hydroxyurea vs RBC transfusions | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Hydroxyurea vs RBC transfusions | no estimate extracted | NR | No studies |
Hydroxyurea compared to RBC transfusion for prevention of SCI in people with SCD who had a stroke (secondary prevention)
Population: prevention of SCI in people with SCD who had a stroke (secondary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of participants developing new or progressive SCI lesions Hydroxyurea vs RBC transfusion | Peto OR 7.28 [0.14, 366.91] | 1 study · 133 participants | Very low Downgraded: risk of bias |
All‐cause mortality Hydroxyurea vs RBC transfusion | OR 1.02 [0.06, 16.41] | 1 study · 133 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ ACS Hydroxyurea vs RBC transfusion | RR 0.33 [0.04, 3.08] | 1 study · 133 participants | Very low Downgraded: risk of bias |
SCD‐related SAEs ‐ Pain crisis Hydroxyurea vs RBC transfusion | RR 3.15 [1.23, 8.11] | 1 study · 133 participants | Low Downgraded: risk of bias |
Clinical stroke Hydroxyurea vs RBC transfusion | RR 14.78 [0.86, 253.66] | 1 study · 133 participants | Very low Downgraded: risk of bias |
Cognitive function ‐ not reported Hydroxyurea vs RBC transfusion | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Hydroxyurea vs RBC transfusion | no estimate extracted | NR | No studies |