Nieves R, Latham T, Marte NM, et al. Stroke prevention in Hispanic children with sickle cell anemia: the SACRED trial. Blood Adv. 2025;9(8):1791-1800.
According to the article, the SACRED trial looked at ways to prevent strokes in Hispanic children with sickle cell anemia (SCA) in the Dominican Republic, focusing on kids whose blood flow in the brain was at a “conditional” risk level.
The article explains that a test called the transcranial Doppler test (TCD) can measure blood flow in the brain and help identify children who are more likely to have a stroke.
The article describes how the trial trained 10 local doctors to do TCD testing and manage hydroxyurea treatment (a medication used to reduce complications of sickle cell). Among the 283 children tested, about 22% had conditional TCD results. This means that measured blood flow in the brain was at a speed that is higher than normal but not yet in the highest-risk range for stroke. The article notes that younger children with these results also tended to have lower hemoglobin (a measure of anemia).
For treatment, the article explains that hydroxyurea was first given at a standard dose for six months, then gradually increased to the highest safe dose (AKA maximum tolerated dose). After six months, about 60% of children’s blood flow results returned to normal, and the average speed in their brain arteries dropped. After increasing to the maximum tolerated dose, 81% had normal results, and these improvements lasted for five years!
However, there were some limitations. First, the children included were not randomly selected—they were chosen based on who was available at the clinic (“convenience sample”), so the results might not apply to all children with SCA. Second, the study didn’t calculate in advance exactly how many children would be needed to see every possible effect, so some findings may be less certain. Third, some children had already been treated with medicines like hydroxyurea before joining the study, which could affect how well the treatment seemed to work.
Written by ~ Tomi Ogunsina
