Clinicians need to pay attention to the risk of stroke in sickle cell disease patients, according to a new study.
Research in California, USA, found that rates of stroke have increased over a 30-year period.
The authors say a range of factors could have contributed to this, including a lack of focus on stroke risk among adult patients, failure to implement guidelines, and uncontrolled lifestyle factors.
The landmark STOP trial, published in 1998, found that transcranial doppler screening to identify high risk children and the use of chronic red blood cell transfusions reduced risk of stroke by 90%.
In this new study, the researchers used real-world data to see what impact these recommendations have made in the intervening years, for both children and adults with sickle cell disease.
The new 30-year analysis of 7,636 patients in California found that the risk of stroke increased with age, with incidence at 60 being 13 times the rate at the age of 20. In total 9.6% of patients experienced at least one cerebrovascular event.
The study, reported in Blood, also showed that rates of stroke have in fact increased over 30 years, with the highest rates occurring in the third decade of the study period, between 2010 and 2019.
The research found frequent hospitalisation, hypertension, high cholesterol and an earlier transient ischaemic attack were associated with increased risk of ischaemic stroke.
Researcher Dr Ted Wun, of the University of California Davis School of Medicine, said: “As haematologists, our training emphasises that the risk of stroke is highest in young children, but I think that has resulted in far less attention being paid to adult patients. We just extrapolate what happens in children to adults, but we don’t know if that’s appropriate or not.
“Even in children, who probably get the best care for patients with sickle cell disease in this country, these trends are opposite what we would hope. Based on these results, it appears that STOP guidelines haven’t been effectively implemented.”
Dr Wun added: “The preventive steps that we know help prevent stroke in the general population are just as important for people living with sickle cell disease."
Source:
Oluwole OB, Brunson A, Adesina OO, Willen S, Keegan TH, Fertrin KY, Wun T. (2024) “Rates of Strokes in Californians with Sickle Cell Disease in the Post-STOP Era.” Blood, 20 September 2024, doi: 10.1182/blood.2023023031.
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