Prophylactic Hydroxyurea Treatment Is Associated with Improved Cerebral Hemodynamics as a Surrogate Marker of Stroke Risk in Sickle Cell Disease: A Retrospective Comparative Analysis

被引:3
作者
Peine, Brian R. [1 ]
Callaghan, Michael U. [1 ,2 ]
Callaghan, Joseph H. [3 ]
Glaros, Alexander K. [1 ,2 ]
机构
[1] Cent Michigan Univ, Coll Med, Clin Res Inst, 1280 S East Campus Dr, Mt Pleasant, MI 48859 USA
[2] Childrens Hosp Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA
[3] Oakland Univ, Sch Business Adm, Accounting Program, 201 Meadow Brook Rd, Rochester, MI 48309 USA
关键词
sickle; ischemic; stroke; trans cranial doppler; average maximum mean velocity; Hydroxyurea; DOPPLER FLOW VELOCITIES; CHILDREN; ANEMIA; TRANSFUSIONS; PREVENTION; THERAPY; HYDROXYCARBAMIDE; MULTICENTER; TRIAL;
D O I
10.3390/jcm11123491
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Sickle cell disease (SCD) increases the incidence of childhood stroke eighty-fold. Stroke risk can be estimated by measurement of the blood velocity through the middle cerebral artery (MCA) using transcranial doppler ultrasound (TCD). A high MCA blood velocity indicates increased stroke risk due to cerebral vasculopathy, and first-line treatment to prevent primary or recurrent strokes in high-risk children with SCD has classically been chronic blood transfusions. Research has more recently shown that many of these patients may safely transition from transfusions to oral hydroxyurea (HU) treatment while maintaining a decreased risk of stroke. However, the effect on stroke risk of truly prophylactic HU treatment beginning in infancy, prior to the onset of cerebral vasculopathy, is less well understood. Our retrospective study aimed to document the long-term effects of HU treatment compared with no HU treatment in children with SCD, using TCD measurements as our primary outcome and a surrogate marker of stroke risk. Our results showed that when accounting for age-related variability and duration of treatment, prophylactic HU treatment was independently associated with lower TCD MCA velocities compared with no HU treatment, providing further evidence supporting its early initiation for patients with SCD.
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页数:12
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