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Red blood cell transfusions may have the stongest analgesic effect during acute painful crises in sickle cell diseases

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Research Article | DOI: https://doi.org/10.31579/2641-0419/364

Red blood cell transfusions may have the stongest analgesic effect during acute painful crises in sickle cell diseases

  • Mehmet Rami Helvaci 1*
  • Saziye Cayir 2, Hulya Halici 2
  • Alper Sevinc 2
  • Celaletdin Camci 1
  • Abdulrazak Abyad 3
  • Lesley Pocock 4

1Specialist of Internal Medicine, MD, Turkey

2Manager of Writing and Statistics, Turkey

3Middle-East Academy for Medicine of Aging, MD, Lebanon

4Medi-WORLD International, Australia

*Corresponding Author: Mehmet Rami Helvaci, Specialist of Internal Medicine, MD, Turkey.

Citation: Mehmet R. Helvaci, Saziye Cayir, Hulya Halici, Alper Sevinc, Celaletdin Camci, et al, (2024), Red blood cell transfusions may have the stongest analgesic effect during acute painful crises in sickle cell diseases, J Clinical Cardiology and Cardiovascular Interventions, 7(5); DOI: 10.31579/2641-0419/364

Copyright: © 2024, Mehmet Rami Helvaci. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 12 April 2024 | Accepted: 08 May 2024 | Published: 24 May 2024

Keywords: sickle cell diseases; acute painful crises; hardened red blood cells; capillary endothelial inflammation; capillary endothelial edema; tissue hypoxia; sudden death

Abstract

Background: The hardened red blood cells (RBC)-induced capillary endothelial damage, inflammation, edema, and fibrosis are initiated at birth, and terminate with disseminated tissue hypoxia, acute painful crises, multiorgan failures, and sudden death even at childhood in the sickle cell diseases (SCD).

Methods: All cases with the SCD were included into the study.

Results: We studied 222 males and 212 females with similar mean ages (30.8 vs 30.3 years, p>0.05, respectively). Disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), cirrhosis (8.1% vs 1.8%, p<0.001), leg ulcers (19.8% vs 7.0%, p<0.001), digital clubbing (14.8% vs 6.6%, p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05), chronic renal disease (9.9% vs 6.1%, p<0.05), chronic obstructive pulmonary disease (25.2% vs 7.0%, p<0.001), and stroke (12.1% vs 7.5%, p<0.05) were all higher but not acute chest syndrome (2.7% vs 3.7%, p>0.05) or pulmonary hypertension (12.6% vs 11.7%, p>0.05) or deep venous thrombosis and/or varices and/or telangiectasias (9.0% vs 6.6%, p>0.05) in males, significantly.

Conclusion: Infections, medical or surgical emergencies, or emotional stress-induced increased basal metabolic rate aggravates the sickling and capillary endothelial inflammation and edema, and may terminate with disseminated tissue hypoxia, acute painful crises, multiorgan failures, and sudden deaths in the SCD. RBC support may have the stongest analgesic effect, and decrease the risk of multiorgan failures and sudden death by decreasing the density of causative hardened cells from the circulation during such severe crises.

Introduction

Chronic endothelial damage may be the major cause of aging and death by causing end-organ failures in human being (1). Much higher blood pressures (BPs) of the afferent vasculature may be the major accelerating factor by causing recurrent injuries on vascular endothelial cells. Probably, whole afferent vasculature including capillaries are mainly involved in the process. Thus the term of venosclerosis is not as famous as atherosclerosis in the literature. Due to the chronic endothelial damage, inflammation, edema, and fibrosis, vascular walls thicken, their lumens narrow, and they lose their elastic natures, those eventually reduce blood supply to the terminal organs, and increase systolic and decrease diastolic BPs further. Some of the well-known accelerating factors of the inflammatory process are physical inactivity, sedentary lifestyle, animal-rich diet, smoking, alcohol, overweight, chronic inflammations, prolonged infections, and cancers for the development of terminal consequences including obesity, hypertension (HT), diabetes mellitus (DM), cirrhosis, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), chronic renal disease (CRD), stroke, peripheric artery disease (PAD), mesenteric ischemia, osteoporosis, dementia, early aging, and premature death (2, 3). Although early withdrawal of the accelerating factors can delay terminal consequences, after development of obesity, HT, DM, cirrhosis, COPD, CRD, CHD, stroke, PAD, mesenteric ischemia, osteoporosis, and dementia-like end-organ insufficiencies and aging, the endothelial changes can not be reversed due to their fibrotic natures, completely. The accelerating factors and terminal consequences of the vascular process are researched under the titles of metabolic syndrome, aging syndrome, and accelerated endothelial damage syndrome in the literature (4-6). On the other hand, sickle cell diseases (SCD) are chronic inflammatory and highly destructive processes on vascular endothelium, initiated at birth and terminated with an advanced atherosclerosis induced end-organ insufficiencies in much earlier ages of life (7, 8). Hemoglobin S causes loss of elastic and biconcave disc shaped structures of red blood cells (RBC). Probably loss of elasticity instead of shape is the major problem because sickling is rare in peripheric blood samples of the cases with associated thalassemia minors (TM), and human survival is not affected in hereditary spherocytosis or elliptocytosis. Loss of elasticity is present during whole lifespan, but exaggerated with inflammations, infections, and additional stresses of the body. The hardened RBC induced chronic endothelial damage, inflammation, edema, and fibrosis terminate with tissue hypoxia all over the body (9). As a difference from other causes of chronic endothelial damage, SCD keep vascular endothelium particularly at the capillary level (10, 11), since the capillary system is the main distributor of the hardened RBC into the tissues. The hardened RBC induced chronic endothelial damage builds up an advanced atherosclerosis in much earlier ages of life. Vascular narrowings and occlusions induced tissue ischemia and end-organ insufficiencies are the final consequences, so the mean life expectancy is decreased by 25 to 30 years for both genders in the SCD (8).

Material and methods

The study was performed in Medical Faculty of the Mustafa Kemal University between March 2007 and June 2016. All patients with the SCD were included. The SCD were diagnosed with the hemoglobin electrophoresis performed via high performance liquid chromatography (HPLC). Medical histories including smoking, alcohol, acute painful crises per year, transfused units of RBC in their lives, leg ulcers, stroke, surgical operations, deep venous thrombosis (DVT), epilepsy, and priapism were learnt. Patients with a history of one pack-year were accepted as smokers, and one drink-year were accepted as drinkers. A complete physical examination was performed by the Same Internist, and patients with disseminated teeth losses (<20>

Results:

The study included 222 males and 212 females with similar ages (30.8 vs 30.3 years, p>0.05, respectively). Prevalences of associated TM were similar in both genders, too (72.5% vs 67.9%, p>0.05, respectively). Smoking (23.8% vs 6.1%) and alcohol (4.9% vs 0.4%) were higher in males (p<0>(Table 1). Transfused units of RBC in their lives (48.1 vs 28.5, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0>0.05) or PHT (12.6% vs 11.7%, p>0.05) or DVT and/or varices and/or telangiectasias (9.0% vs 6.6%, p>0.05) in males, significantly. Although the mean age of mortality (30.2 vs 33.3 years) was lower in males, the difference was not significant, probably due to the small sample size of the study cases (Table 2). Interestingly, mean ages of the stroke (33.5 years), COPD (33.6 years), digital clubbing (35.4 years), CHD (35.7 years), cirrhosis (37.0 years), and CRD (39.4 years) were the highest among the other atherosclerotic consequences in the SCD (Table 3)

VariablesMale patients with SCD*p-valueFemale patients with SCD
Prevalence51.1% (222)Ns†48.8% (212)
Mean age (year)30.8 ± 10.0 (5-58)Ns30.3 ± 9.9 (8-59)
Associated TM‡72.5% (161)Ns67.9% (144)
Smoking23.8% (53)<0>6.1% (13)
Alcoholism4.9% (11)<0>0.4% (1)

Table 1: Characteristic features of the study cases

VariablesMale patients with SCD*p-valueFemale patients with SCD
Painful crises per year5.0 ± 7.1 (0-36)Ns†4.9 ± 8.6 (0-52)
Transfused units of RBC‡48.1 ± 61.8 (0-434)0.00028.5 ± 35.8 (0-206)
Disseminated teeth losses (<20>5.4% (12)<0>1.4% (3)
COPD§25.2% (56)<0>7.0% (15)
Ileus7.2% (16)<0>1.4% (3)
Cirrhosis8.1% (18)<0>1.8% (4)
Leg ulcers19.8% (44)<0>7.0% (15)
Digital clubbing14.8% (33)<0>6.6% (14)
CHD¶18.0% (40)<0>13.2% (28)
CRD**9.9% (22)<0>6.1% (13)
Stroke12.1% (27)<0>7.5% (16)
PHT***12.6% (28)Ns11.7% (25)
Autosplenectomy50.4% (112)Ns53.3% (113)
DVT**** and/or varices and/or telangiectasias9.0% (20)Ns6.6% (14)
Rheumatic heart disease6.7% (15)Ns5.6% (12)
Avascular necrosis of bones24.3% (54)Ns25.4% (54)
Sickle cell retinopathy0.9% (2)Ns0.9% (2)
Epilepsy2.7% (6)Ns2.3% (5)
ACS*****2.7% (6)Ns3.7% (8)
Mortality7.6% (17)Ns6.6% (14)
Mean age of mortality (year)30.2 ± 8.4 (19-50)Ns33.3 ± 9.2 (19-47)

Table 2: Associated pathologies of the study cases

*Sickle cell diseases   †Nonsignificant (p>0.05)   ‡Red blood cells   §Chronic obstructive pulmonary disease  ¶Coronary heart disease   **Chronic renal disease   ***Pulmonary hypertension   ****Deep venous thrombosis   *****Acute chest syndrome

VariablesMean age (year)
Ileus29.8 ± 9.8 (18-53)
Hepatomegaly30.2 ± 9.5 (5-59)
ACS*30.3 ± 10.0 (5-59)
Sickle cell retinopathy31.5 ± 10.8 (21-46)
Rheumatic heart disease31.9 ± 8.4 (20-49)
Autosplenectomy32.5 ± 9.5 (15-59)
Disseminated teeth losses (<20>32.6 ± 12.7 (11-58)
Avascular necrosis of bones32.8 ± 9.8 (13-58)
Epilepsy33.2 ± 11.6 (18-54)
Priapism33.4 ± 7.9 (18-51)
Left lobe hypertrophy of the liver33.4 ± 10.7 (19-56)
Stroke33.5 ± 11.9 (9-58)
COPD†33.6 ± 9.2 (13-58)
PHT‡34.0 ± 10.0 (18-56)
Leg ulcers35.3 ± 8.8 (17-58)
Digital clubbing35.4 ± 10.7 (18-56)
CHD§35.7 ± 10.8 (17-59)
DVT¶ and/or varices and/or telangiectasias37.0 ± 8.4 (17-50)
Cirrhosis37.0 ± 11.5 (19-56)
CRD**39.4 ± 9.7 (19-59)

Table 3: Mean ages of the consequences of the sickle cell diseases

*Acute chest syndrome   †Chronic obstructive pulmonary disease   ‡Pulmonary hypertension   §Coronary heart disease  ¶Deep venous thrombosis   **Chronic renal disease

Discussion

Acute painful crises are the most disabling symptoms of the SCD. Although some authors reported that pain itself may not be life threatening directly, infections, medical or surgical emergencies, or emotional stress are the most common precipitating factors of the crises (19). The increased basal metabolic rate during such stresses aggravates the sickling, capillary endothelial damage, inflammation, edema, tissue hypoxia, and multiorgan insufficiencies. So the risk of mortality is much higher during the crises. Actually, each crisis may complicate with the following crises by leaving significant sequelaes on the capillary endothelial system all over the body. After a period of time, the sequelaes may terminate with sudden end-organ failures and death during a final acute painful crisis that may even be silent, clinically. Similarly, after a 20-year experience on such patients, the deaths seem sudden and unexpected events in the SCD. Unfortunately, most of the deaths develop just after the hospital admission, and majority of them are patients without hydroxyurea therapy (23, 24). Rapid RBC supports are usually life-saving for such patients, although preparation of RBC units for transfusion usually takes time. Beside that RBC supports in emergencies become much more difficult in terminal cases due to the repeated transfusions-induced blood group mismatch. Actually, transfusion of each unit of RBC complicates the following transfusions by means of the blood subgroup mismacth. Due to the significant efficacy of hydroxyurea therapy, RBC transfusions should be kept just for acute events and emergencies in the SCD (23, 24). According to our experiences, simple and repeated transfusions are superior to RBC exchange in the SCD (25, 26). First of all, preparation of one or two units of RBC suspensions in each time rather than preparation of six units or higher provides time to clinicians to prepare more units by preventing sudden death of such high-risk patients. Secondly, transfusions of one or two units of RBC suspensions in each time decrease the severity of pain, and relax anxiety of the patients and their relatives since RBC transfusions probably have the strongest analgesic effects during the crises. Actually, the decreased severity of pain by transfusions also indicates the decreased severity of inflammation all over the body. Thirdly, transfusions of lesser units of RBC suspensions in each time by means of the simple transfusions will decrease transfusion-related complications including infections, iron overload, and blood group mismatch in the future. Fourthly, transfusion of RBC suspensions in the secondary health centers may prevent some deaths developed during the transport to the tertiary centers for the exchange. Finally, cost of the simple and repeated transfusions on insurance system is much lower than the exchange that needs trained staff and additional devices. On the other hand, pain is the result of complex and poorly understood interactions between RBC, white blood cells (WBCs), platelets (PLTs), and endothelial cells, yet. Whether leukocytosis contributes to the pathogenesis by releasing cytotoxic enzymes is unknown. The adverse actions of WBCs on endothelium are of particular interest with regard to the cerebrovascular diseases in the SCD. For example, leukocytosis even in the absence of any infection was an independent predictor of the severity of the SCD (20), and it was associated with the risk of stroke in a cohort of Jamaican patients (21). Disseminated tissue hypoxia, releasing of inflammatory mediators, bone infarctions, and activation of afferent nerves may take role in the pathophysiology of the intolerable pain. Because of the severity of pain, narcotic analgesics are usually required to control them (22), but according to our practice, simple and repeated RBC transfusions may be highly effective both to relieve pain and to prevent sudden death that may develop secondary to multiorgan failures on the chronic inflammatory background of the SCD.

Hydroxyurea may be the only life-saving drug for the treatment of the SCD. It interferes with the cell division by blocking the formation of deoxyribonucleotides by means of inhibition of ribonucleotide reductase. The deoxyribonucleotides are the building blocks of DNA. Hydroxyurea mainly affects hyperproliferating cells. Although the action way of hydroxyurea is thought to be the increase in gamma-globin synthesis for fetal hemoglobin (Hb F), its main action may be the suppression of leukocytosis and thrombocytosis by blocking the DNA synthesis in the SCD (27, 28). By this way, the chronic inflammatory and destructive process of the SCD is suppressed with some extent. Due to the same action way, hydroxyurea is also used in moderate and severe psoriasis to suppress hyperproliferating skin cells. As in the viral hepatitis cases, although presence of a continuous damage of sickle cells on the capillary endothelium, the severity of destructive process is probably exaggerated by the patients’ own WBCs and PLTs. So suppression of proliferation of them may limit the endothelial damage-induced edema, ischemia, and infarctions in whole body (29). Similarly, final Hb F levels in hydroxyurea users did not differ from their pretreatment levels (30). The Multicenter Study of Hydroxyurea (MSH) studied 299 severely affected adults with the SCA, and compared the results of patients treated with hydroxyurea or placebo (31). The study particularly researched effects of hydroxyurea on painful crises, ACS, and requirement of blood transfusion. The outcomes were so overwhelming in the favour of hydroxyurea that the study was terminated after 22 months, and hydroxyurea was initiated for all patients. The MSH also demonstrated that patients treated with hydroxyurea had a 44

References

  1. Widlansky ME, Gokce N, Keaney JF Jr, Vita JA. (2003).The clinical implications of endothelial dysfunction. J Am Coll Cardiol; 42(7): 1149-60.
    View at Publisher | View at Google Scholar
  2. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365(9468): 1415-1428.
    View at Publisher | View at Google Scholar
  3. Franklin SS, Barboza MG, Pio JR, Wong ND. (2006)Blood pressure categories, hypertensive subtypes, and the metabolic syndrome. J Hypertens; 24(10): 2009-2016.
    View at Publisher | View at Google Scholar
  4. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation; 106(25): 3143-3421.
    View at Publisher | View at Google Scholar
  5. Helvaci MR, Aydin LY, Aydin Y. (2012).Digital clubbing may be an indicator of systemic atherosclerosis even at microvascular level. HealthMED; 6(12): 3977-3981.
    View at Publisher | View at Google Scholar
  6. Anderson RN, Smith BL. Deaths(2003): leading causes for 2001. Natl Vital Stat Rep; 52(9): 1-85.
    View at Publisher | View at Google Scholar
  7. Helvaci MR, Gokce C, Davran R, Akkucuk S, Ugur M, Oruc C. (2015).Mortal quintet of sickle cell diseases. Int J Clin Exp Med; 8(7): 11442-11448.
    View at Publisher | View at Google Scholar
  8. Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, et al. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med 1994; 330(23): 1639-1644.
    View at Publisher | View at Google Scholar
  9. Helvaci MR, Yaprak M, Abyad A, Pocock L.(2018).Atherosclerotic background of hepatosteatosis in sickle cell diseases. World Family Med; 16(3): 12-18.
    View at Publisher | View at Google Scholar
  10. Helvaci MR, Kaya H. (2011).Effect of sickle cell diseases on height and weight. Pak J Med Sci; 27(2): 361-4.
    View at Publisher | View at Google Scholar
  11. Helvaci MR, Aydin Y, Ayyildiz O. Hydroxyurea may prolong survival of sickle cell patients by decreasing frequency of painful crises. HealthMED 2013; 7(8): 2327-32.
    View at Publisher | View at Google Scholar
  12. Mankad VN, Williams JP, Harpen MD, Manci E, Longenecker G, Moore RB, et al. Magnetic resonance imaging of bone marrow in sickle cell disease: clinical, hematologic, and pathologic correlations. Blood 1990; 75(1): 274-83.
    View at Publisher | View at Google Scholar
  13. Helvaci MR, Aydin Y, Ayyildiz O. Clinical severity of sickle cell anemia alone and sickle cell diseases with thalassemias. HealthMED 2013; 7(7): 2028-33.
    View at Publisher | View at Google Scholar
  14. Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, et al. (2009).Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med; 179(7): 615-621.
    View at Publisher | View at Google Scholar
  15. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. (2013).Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med; 187(4): 347-65.
    View at Publisher | View at Google Scholar
  16. Davies SC, Luce PJ, Win AA, Riordan JF, Brozovic M. (1984).Acute chest syndrome in sickle-cell disease. Lancet; 1(8367): 36-38.
    View at Publisher | View at Google Scholar
  17. Vandemergel X, Renneboog B. Prevalence, (2008).aetiologies and significance of clubbing in a department of general internal medicine. Eur J Intern Med; 19(5): 325-9.
    View at Publisher | View at Google Scholar
  18. Schamroth L. (1976).Personal experience. S Afr Med J 50(9): 297-300.
    View at Publisher | View at Google Scholar
  19. Parfrey NA, Moore W, Hutchins GM. (1985). Is pain crisis a cause of death in sickle cell disease? Am J Clin Pathol; 84: 209-212.
    View at Publisher | View at Google Scholar
  20. Helvaci MR, Ayyildiz O, Gundogdu M. (2014).Hydroxyurea therapy and parameters of health in sickle cell patients. HealthMED 2; 8(4): 451-456.
    View at Publisher | View at Google Scholar
  21. Helvaci MR, Tonyali O, Yaprak M, Abyad A, Pocock L.(2019).Increased sexual performance of sickle cell patients with hydroxyurea. World Family Med; 17(4): 28-33.
    View at Publisher | View at Google Scholar
  22. Helvaci MR, Atci N, Ayyildiz O, Muftuoglu OE, Pocock L. (2013).Red blood cell supports in severe clinical conditions in sickle cell diseases. World Family Med 2016; 14(5): 11-8.
    View at Publisher | View at Google Scholar
  23. Helvaci MR, Ayyildiz O, Gundogdu M. Red blood cell transfusions and survival of sickle cell patients. HealthMED; 7(11): 2907-2912.
    View at Publisher | View at Google Scholar
  24. Miller ST, Sleeper LA, Pegelow CH, Enos LE, Wang WC, Weiner SJ, et al. (2000).Prediction of adverse outcomes in children with sickle cell disease. N Engl J Med; 342: 83-89.
    View at Publisher | View at Google Scholar
  25. Balkaran B, Char G, Morris JS, Thomas PW, Serjeant BE, Serjeant GR. (1992).Stroke in a cohort of patients with homozygous sickle cell disease. J PediatrC; 120: 360-366.
    View at Publisher | View at Google Scholar
  26. Cole TB, Sprinkle RH, Smith SJ, Buchanan GR. (1986)Intravenous narcotic therapy for children with severe sickle cell pain crisis. Am J Dis Child; 140: 1255-1259.
    View at Publisher | View at Google Scholar
  27. Miller BA, Platt O, Hope S, Dover G, Nathan DG. (1987).Influence of hydroxyurea on fetal hemoglobin production in vitro. Blood; 70(6): 1824-1829.
    View at Publisher | View at Google Scholar
  28. Platt OS. (1988).Is there treatment for sickle cell anemia? N Engl J Med; 319(22): 1479-80.
    View at Publisher | View at Google Scholar
  29. Helvaci MR, Aydogan F, Sevinc A, Camci C, Dilek I. (2014).Platelet and white blood cell counts in severity of sickle cell diseases. Pren Med Argent; 100(1): 49-56.
    View at Publisher | View at Google Scholar
  30. Charache S. (1997).Mechanism of action of hydroxyurea in the management of sickle cell anemia in adults. Semin Hematol; 34(3): 15-21.
    View at Publisher | View at Google Scholar
  31. Charache S, Barton FB, Moore RD, Terrin ML, Steinberg MH, Dover GJ, et al. (1996).Hydroxyurea and sickle cell anemia. Clinical utility of a myelosuppressive
    View at Publisher | View at Google Scholar
  32. Steinberg MH, Barton F, Castro O, Pegelow CH, Ballas SK, Kutlar A, et al. (2003).Effect of hydroxyurea on mortality and morbidity in adult sickle cell anemia: risks and benefits up to 9 years of treatment. JAMA ; 289(13): 1645-51.
    View at Publisher | View at Google Scholar
  33. Lebensburger JD, Miller ST, Howard TH, Casella JF, Brown RC, Lu M, et al; (2012).BABY HUG Investigators. Influence of severity of anemia on clinical findings in infants with sickle cell anemia: analyses from the BABY HUG study. Pediatr Blood Cancer ; 59(4): 675-8.
    View at Publisher | View at Google Scholar
  34. Toghi H, Konno S, Tamura K, Kimura B, Kawano K. (2002). Effects of low-to-high doses of aspirin on platelet aggregability and metabolites of thromboxane A2 and prostacyclin. Stroke ; 23(10): 1400-1403.
    View at Publisher | View at Google Scholar
  35. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. (2009).Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet ; 373(9678): 1849-60.
    View at Publisher | View at Google Scholar
  36. Algra AM, Rothwell PM. (2021).Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials. Lancet Oncol; 13(5): 518-527.
    View at Publisher | View at Google Scholar
  37. Macdonald S. (2002).Aspirin use to be banned in under 16 year olds. BMJ; 325(7371): 988.
    View at Publisher | View at Google Scholar
  38. Schrör K. Aspirin and Reye (2007). syndrome: a review of the evidence. Paediatr Drugs ; 9(3): 195-204.
    View at Publisher | View at Google Scholar
  39. Pugliese A, Beltramo T, Torre D. Reye’s and Reye’s(2018).-like syndromes. Cell Biochem Funct; 26(7): 741-746.
    View at Publisher | View at Google Scholar
  40. Hurwitz ES. Reye’s syndrome. Epidemiol Rev 1989; 11: 249-253.
    View at Publisher | View at Google Scholar
  41. Meremikwu MM, Okomo U. Sickle cell disease. BMJ Clin Evid 2011; 2011: 2402.
    View at Publisher | View at Google Scholar
  42. Mohamed S, Fong CM, Ming YJ, Kori AN, Wahab SA, Ali ZM. Evaluation of an initiation regimen of warfarin for international normalized ratio target 2.0 to 3.0. J Pharm Technol 2021; 37(6): 286-292.
    View at Publisher | View at Google Scholar
  43. Chu MWA, Ruel M, Graeve A, Gerdisch MW, Ralph J, Damiano Jr RJ, Smith RL. Low-dose vs standard warfarin after mechanical mitral valve replacement: A randomized trial. Ann Thorac Surg 2023; 115(4): 929-38.
    View at Publisher | View at Google Scholar
  44. Crowther MA, Douketis JD, Schnurr T, Steidl L, Mera V, Ultori C, et al. Oral vitamin K lowers the international normalized ratio more rapidly than subcutaneously vitamin K in the treatment of warfarin-associated coagulopathy. A randomized, controlled trial. Ann Intern Med 2002; 137(4): 251-254.
    View at Publisher | View at Google Scholar
  45. Brown DG, Wilkerson EC, Love WE. A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons. J Am Acad Dermatol 2015; 72(3): 524-534.
    View at Publisher | View at Google Scholar
  46. Delaney JA, Opatrny L, Brophy JM, Suissa S. (2007).Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ; 177(4): 347-351.
    View at Publisher | View at Google Scholar
  47. Dahal K, Kunwar S, Rijal J, Schulman P, Lee J. (2016).Stroke, major bleeding, and mortality outcomes in warfarin users with atrial fibrillation and chronic kidney disease: a meta-analysis of observational studies. Chest; 149(4): 951-9.
    View at Publisher | View at Google Scholar
  48. Chai-Adisaksopha C, Lorio A, Hillis C, Siegal D, Witt DM, Schulman S, et al. (2017).Warfarin resumption following anticoagulant-associated intracranial hemorrhage: A systematic review and meta-analysis. Thromb Res; 160: 97-104.
    View at Publisher | View at Google Scholar
  49. Ferro JM, Coutinho JM, Dentali F, Kobayashi A, Alasheev A, Canhao P, (2019) et al. Safety and efficacy of dabigatran etexilate vs dose-adjusted warfarin in patients with cerebral venous thrombosis: A randomized clinical trial. JAMA Neurol; 76(12): 1457-65.
    View at Publisher | View at Google Scholar
  50. Meade TW. (1990).Low-dose warfarin and low-dose aspirin in the primary prevention of ischemic heart disease. Am J Cardiol; 65(6): 7C-11C.
    View at Publisher | View at Google Scholar
  51. Singer DE, Hughes RA, Gress DR, Sheehan MA, Oertel LB, Maraventano SW, et al. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 1990; 323(22): 1505-11.
    View at Publisher | View at Google Scholar
  52. Levine M, Hirsh J, Gent M, Arnold A, Warr D, Falanya A, et al. (1994).Double-blind randomised trial of a very-low-dose warfarin for prevention of thromboembolism in stage IV breast cancer. Lancet; 343(8902): 886-9.
    View at Publisher | View at Google Scholar
  53. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 383(9921): 955-962.
    View at Publisher | View at Google Scholar
  54. Vinogradova Y, Coupland C, Hill T, Hippisley-Cox J. (2018). Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ; 362: k2505.
    View at Publisher | View at Google Scholar
  55. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. (2009) .Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med; 361(12): 1139-51.
    View at Publisher | View at Google Scholar
  56. Helvaci MR, Vural A, Onay K, Abyad A, Pocock L. (2023). Low-dose warfarin may be a life-saving treatment regimen in sickle cell diseases. World Family Med; 21(7): 21-35.
    View at Publisher | View at Google Scholar
  57. Helvaci MR, Erden ES, Aydin LY.(2013).Atherosclerotic background of chronic obstructive pulmonary disease in sickle cell patients. HealthMED; 7(2): 484-498.
    View at Publisher | View at Google Scholar
  58. Rennard SI, Drummond MB. Early chronic obstructive pulmonary disease: definition, assessment, and prevention. Lancet 2015; 385(9979): 1778-1788.
    View at Publisher | View at Google Scholar
  59. Schoepf D, Heun R. Alcohol dependence and physical comorbidity: Increased prevalence but reduced relevance of individual comorbidities for hospital-based mortality during a 12.5-year observation period in general hospital admissions in urban North-West England. Eur Psychiatry 2015; 30(4): 459-468.
    View at Publisher | View at Google Scholar
  60. Singh G, Zhang W, Kuo YF, Sharma G. (2016).Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD. Chest; 149(4): 905-15.
    View at Publisher | View at Google Scholar
  61. Danesh J, Collins R, Appleby P, Peto R. (1998).Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA; 279(18): 1477-1482.
    View at Publisher | View at Google Scholar
  62. Mannino DM, Watt G, Hole D, Gillis C, Hart C, McConnachie A, et al. (2006).The natural history of chronic obstructive pulmonary disease. Eur Respir J; 27(3): 627-43.
    View at Publisher | View at Google Scholar
  63. Mapel DW, Hurley JS, Frost FJ, Petersen HV, Picchi MA, Coultas DB. (2000). Health care utilization in chronic obstructive pulmonary disease. A case-control study in a health maintenance organization. Arch Intern Med; 160(17): 2653-2658.
    View at Publisher | View at Google Scholar
  64. Anthonisen NR, Connett JE, Enright PL, Manfreda J; (2002). Lung Health Study Research Group. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med; 166(3): 333-339.
    View at Publisher | View at Google Scholar
  65. McGarvey LP, John M, Anderson JA, Zvarich M, Wise RA; (2007).TORCH Clinical Endpoint Committee. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax; 62(5): 411-415.
    View at Publisher | View at Google Scholar
  66. Myers KA, Farquhar DR. (2001).The rational clinical examination. Does this patient have clubbing? JAMA; 286(3): 341-347.
    View at Publisher | View at Google Scholar
  67. Toovey OT, Eisenhauer HJ. (2010).A new hypothesis on the mechanism of digital clubbing secondary to pulmonary pathologies. Med Hypotheses; 75(6): 511-3.
    View at Publisher | View at Google Scholar
  68. Trent JT, Kirsner RS. Leg ulcers in sickle cell disease. Adv Skin Wound Care 2004: 17(8); 410-416.
    View at Publisher | View at Google Scholar
  69. Minniti CP, Eckman J, Sebastiani P, Steinberg MH, Ballas SK. (2010).Leg ulcers in sickle cell disease. Am J Hematol; 85(10): 831-833.
    View at Publisher | View at Google Scholar
  70. Yawn BPs, Buchanan GR, Afenyi-Annan AN, Ballas SK, Hassell KL, James AH, et al. (2014). Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA; 312(10): 1033-1048.
    View at Publisher | View at Google Scholar
  71. Helvaci MR, Aydogan F, Sevinc A, Camci C, Dilek I. Platelet and white blood cell counts in severity of sickle cell diseases. HealthMED 2014; 8(4): 477-482.
    View at Publisher | View at Google Scholar
  72. Bhatia LS, Curzen NP, Calder PC, Byrne CD. Non-alcoholic fatty liver disease: a new and important cardiovascular risk factor? Eur Heart J 2012; 33(10): 1190-1200.
    View at Publisher | View at Google Scholar
  73. Pacifico L, Nobili V, Anania C, Verdecchia P, Chiesa C. (2011).Pediatric nonalcoholic fatty liver disease, metabolic syndrome and cardiovascular risk. World J Gastroenterol; 17(26): 3082-3091.
    View at Publisher | View at Google Scholar
  74. Mawatari S, Uto H, Tsubouchi H. Chronic liver disease and arteriosclerosis. Nihon Rinsho 2011; 69(1): 153-157.
    View at Publisher | View at Google Scholar
  75. Bugianesi E, Moscatiello S, Ciaravella MF, Marchesini G. Insulin resistance in nonalcoholic fatty liver disease. Curr Pharm Des 2010; 16(17): 1941-1951.
    View at Publisher | View at Google Scholar
  76. Helvaci MR, Aydin LY, Aydin Y. (2012).Chronic obstructive pulmonary disease may be one of the terminal end points of metabolic syndrome. Pak J Med Sci; 28(3): 376-379.
    View at Publisher | View at Google Scholar
  77. Mostafa A, Mohamed MK, Saeed M, Hasan A, Fontanet A, Godsland I, et al. (2010) Hepatitis C infection and clearance: impact on atherosclerosis and cardiometabolic risk factors. Gut; 59(8): 1135-1140.
    View at Publisher | View at Google Scholar
  78. Helvaci MR, Ayyildiz O, Gundogdu M, Aydin Y, Abyad A, Pocock L. (2018).Hyperlipoproteinemias may actually be acute phase reactants in the plasma. World Family Med; 16(1): 7-10.
    View at Publisher | View at Google Scholar
  79. Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlane P, Ruzicka M, et al. (2008).Guidelines for the management of chronic kidney disease. CMAJ; 179(11): 1154-62.
    View at Publisher | View at Google Scholar
  80. Nassiri AA, Hakemi MS, Asadzadeh R, Faizei AM, Alatab S, Miri R, et al. (2012).Differences in cardiovascular disease risk factors associated with maximum and mean carotid intima-media thickness among hemodialysis patients. Iran J Kidney Dis; 6(3): 203-208.
    View at Publisher | View at Google Scholar
  81. Helvaci MR, Gokce C, Sahan M, Hakimoglu S, Coskun M, Gozukara KH. Venous involvement in sickle cell diseases. Int J Clin Exp Med 2016; 9(6): 11950-7.
    View at Publisher | View at Google Scholar
  82. Xia M, Guerra N, Sukhova GK, Yang K, Miller CK, Shi GP, et al. (2011) Immune activation resulting from NKG2D/ligand interaction promotes atherosclerosis. Circulation; 124(25): 2933-2943.
    View at Publisher | View at Google Scholar
  83. Hall JE, Henegar JR, Dwyer TM, Liu J, da Silva AA, Kuo JJ, et al. (2004).Is obesity a major cause of chronic kidney disease? Adv Ren Replace Ther; 11(1): 41-54.
    View at Publisher | View at Google Scholar
  84. Nerpin E, Ingelsson E, Risérus U, Helmersson-Karlqvist J, Sundström J, Jobs E, et al. (2012).Association between glomerular filtration rate and endothelial function in an elderly community cohort. Atherosclerosis; 224(1): 242-246.
    View at Publisher | View at Google Scholar
  85. Stengel B, Tarver-Carr ME, Powe NR, Eberhardt MS, Brancati FL. Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology 2003; 14(4): 479-87.
    View at Publisher | View at Google Scholar
  86. Bonora E, Targher G. Increased risk of cardiovascular disease and chronic kidney disease in NAFLD. Nat Rev Gastroenterol Hepatol 2012; 9(7): 372-381.
    View at Publisher | View at Google Scholar
  87. Helvaci MR, Cayir S, Halici H, Sevinc A, Camci C, Sencan H, Davran R, Abyad A, Pocock L. (2024).Acute chest syndrome and coronavirus disease may actually be genetically determined exaggerated immune response syndromes particularly in pulmonary capillaries. World Family Med; 22(3): 6-16.
    View at Publisher | View at Google Scholar
  88. Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, et al. (2006). Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol; 17(7): 2034-2047.
    View at Publisher | View at Google Scholar
  89. Helvaci MR, Aydin Y, Aydin LY. (2013).Atherosclerotic background of chronic kidney disease in sickle cell patients. HealthMED; 7(9): 2532-2537.
    View at Publisher | View at Google Scholar
  90. DeBaun MR, Gordon M, McKinstry RC, Noetzel MJ, White DA, Sarnaik SA, et al. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. N Engl J Med 2014; 371(8): 699-710.
    View at Publisher | View at Google Scholar
  91. Gueguen A, Mahevas M, Nzouakou R, Hosseini H, Habibi A, Bachir D, et al. Sickle-cell disease stroke throughout life: a retrospective study in an adult referral center. Am J Hematol 2014; 89(3): 267-272.
    View at Publisher | View at Google Scholar
  92. Majumdar S, Miller M, Khan M, Gordon C, Forsythe A, Smith MG, et al. (2014).Outcome of overt stroke in sickle cell anaemia, a single institution's experience. Br J Haematol; 165(5): 707-713.
    View at Publisher | View at Google Scholar
  93. Kossorotoff M, Grevent D, de Montalembert M. (2014).Cerebral vasculopathy in pediatric sickle-cell anemia. Arch Pediatr 21(4): 404-14.
    View at Publisher | View at Google Scholar
  94. Charache S, Terrin ML, Moore RD, Dover GJ, Barton FB, Eckert SV, et al. (1995).Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med; 332(20): 1317-1322.
    View at Publisher | View at Google Scholar

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Dr Marcelo Flavio Gomes Jardim Filho

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Dr Susan Weiner