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[Comment] New option for primary stroke prevention in sickle cell anaemia

The results of the TWiTCH trial1 establish a new standard of care for primary stroke prevention in children with sickle cell anaemia and high transcranial doppler (TCD) flow velocities (≥200 cm/s). In this high-risk group, the incidence of strokes per year is about <1% with regular blood transfusion therapy and approximately 10–13% without.2 Transfusion therapy has been reported2 to confer a 92% relative risk reduction and a 14·8% absolute risk reduction for stroke after the completion of the trial,3 corresponding to a number needed to treat of seven: ie, for every seven children with high TCD measurements who are treated with blood transfusion therapy, one stroke will be prevented.