Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Is High-Dose Aspirin Necessary in the Acute Phase of Kawasaki Disease?

  • Lee, Goni (Department of Pediatrics, Ewha Womans University School of Medicine, Mokdong Hospital) ;
  • Lee, Seung Eun (Department of Pediatrics, Ewha Womans University School of Medicine, Mokdong Hospital) ;
  • Hong, Young Mi (Department of Pediatrics, Ewha Womans University School of Medicine, Mokdong Hospital) ;
  • Sohn, Sejung (Department of Pediatrics, Ewha Womans University School of Medicine, Mokdong Hospital)
  • Published : 2013.03.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: We sought to determine whether high-dose aspirin is necessary for the acute therapy of Kawasaki disease (KD) in the intravenous immunoglobulin (IVIG) era. Subjects and Methods: Two groups of KD patients treated during the different periods were included. Study group (n=51, treated with IVIG without concomitant use of aspirin in the acute phase) was compared with control group (n=129, treated with IVIG plus high-dose aspirin) with regard to the response to IVIG, duration of fever after IVIG completion, time to C-reactive protein (CRP) <3 mg/dL, and the incidence of coronary artery lesions (CALs). Results: There was no difference between the groups in age, sex, and duration of fever before treatment. Pre-IVIG laboratory measures also did not differ from each other. IVIG-resistant cases were 8 (15.7%) in study group and 22 (17.1%) in control group (p=1.000). Mean duration of fever after IVIG completion in IVIG-responsive patients was $13.3{\pm}13.5$ hours in study group compared to $6.2{\pm}8.3$ hours in control group (p=0.000). The mean time to decrease in CRP was $4.0{\pm}1.7$ days in study group and $4.1{\pm}2.2$ days in control group (p=0.828). There were 2 (3.9%) patients with CALs in study group and 10 (7.8%) in control group (p=0.514). Conclusion: Although high-dose aspirin shortens the duration of fever, treatment without aspirin in the acute phase has no influence on the response to IVIG, resolution of inflammation, or the development of CALs. In the IVIG era, high-dose aspirin may provide little benefit to the treatment in the acute phase of KD.

Keywords

References

  1. Dajani AS, Taubert KA, Gerber MA, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993;87:1776-80. https://doi.org/10.1161/01.CIR.87.5.1776
  2. Kusakawa S, Tatara K. Efficacies and risks of aspirin in the treatment of the Kawasaki disease. Prog Clin Biol Res 1987;250:401-13.
  3. Matsubara T, Mason W, Kashani IA, Kligerman M, Burns JC. Gastrointestinal hemorrhage complicating aspirin therapy in acute Kawasaki disease. J Pediatr 1996;128(5 Pt 1):701-3. https://doi.org/10.1016/S0022-3476(96)80140-5
  4. Sundel RP, Newburger JW, McGill T, et al. Sensorineural hearing loss associated with Kawasaki disease. J Pediatr 1990;117:371-7. https://doi.org/10.1016/S0022-3476(05)81075-3
  5. Lee JH, Hung HY, Huang FY. Kawasaki disease with Reye syndrome: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1992; 33:67-71.
  6. Koren G, MacLeod SM. Difficulty in achieving therapeutic serum concentrations of salicylate in Kawasaki disease. J Pediatr 1984;105:991-5. https://doi.org/10.1016/S0022-3476(84)80097-9
  7. Koren G, Schaffer F, Silverman E, et al. Determinants of low serum concentrations of salicylates in patients with Kawasaki disease. J Pediatr 1988;112:663-7. https://doi.org/10.1016/S0022-3476(88)80194-X
  8. Koren G, Silverman E, Sundel R, et al. Decreased protein binding of salicylates in Kawasaki disease. J Pediatr 1991;118:456-9. https://doi.org/10.1016/S0022-3476(05)82168-7
  9. Durongpisitkul K, Gururaj VJ, Park JM, Martin CF. The prevention of coronary artery aneurysm in Kawasaki disease: a meta-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrics 1995;96:1057-61.
  10. Terai M, Shulman ST. Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr 1997;131:888-93. https://doi.org/10.1016/S0022-3476(97)70038-6
  11. Kim HK, Oh J, Hong YM, Sohn S. Parameters to guide retreatment after initial intravenous immunoglobulin therapy in kawasaki disease. Korean Circ J 2011;41:379-84. https://doi.org/10.4070/kcj.2011.41.7.379
  12. Kobayashi T, Inoue Y, Takeuchi K, et al. Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 2006;113:2606-12. https://doi.org/10.1161/CIRCULATIONAHA.105.592865
  13. Research committee on Kawasaki disease. Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Tokyo: Ministry of Health and Welfare; 1984.
  14. Burns JC, Glode MP, Clarke SH, Wiggins J Jr, Hathaway WE. Coagulopathy and platelet activation in Kawasaki syndrome: identification of patients at high risk for development of coronary artery aneurysms. J Pediatr 1984;105:206-11. https://doi.org/10.1016/S0022-3476(84)80114-6
  15. Yokoyama T, Kato H, Ichinose E. Aspirin treatment and platelet function in Kawasaki disease. Kurume Med J 1980;27:57-61. https://doi.org/10.2739/kurumemedj.27.57
  16. Akagi T, Kato H, Inoue O, Sato N. A study on the optimal dose of aspirin therapy in Kawasaki disease--clinical evaluation and arachidonic acid metabolism. Kurume Med J 1990;37:203-8. https://doi.org/10.2739/kurumemedj.37.203
  17. Ratnatunga CP, Edmondson SF, Rees GM, Kovacs IB. High-dose aspirin inhibits shear-induced platelet reaction involving thrombin generation. Circulation 1992;85:1077-82. https://doi.org/10.1161/01.CIR.85.3.1077
  18. Hsieh KS, Weng KP, Lin CC, Huang TC, Lee CL, Huang SM. Treatment of acute Kawasaki disease: aspirin's role in the febrile stage revisited. Pediatrics 2004;114:e689-93. https://doi.org/10.1542/peds.2004-1037
  19. Burns JC, Capparelli EV, Brown JA, Newburger JW, Glode MP. Intravenous gamma-globulin treatment and retreatment in Kawasaki disease. US/Canadian Kawasaki Syndrome Study Group. Pediatr Infect Dis J 1998;17:1144-8. https://doi.org/10.1097/00006454-199812000-00009
  20. Wallace CA, French JW, Kahn SJ, Sherry DD. Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics 2000;105:E78. https://doi.org/10.1542/peds.105.6.e78
  21. Saulsbury FT. Comparison of high-dose and low-dose aspirin plus intravenous immunoglobulin in the treatment of Kawasaki syndrome. Clin Pediatr (Phila) 2002;41:597-601. https://doi.org/10.1177/000992280204100807
  22. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-71. https://doi.org/10.1161/01.CIR.0000145143.19711.78
  23. de Zorzi A, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger JW. Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr 1998;133:254-8. https://doi.org/10.1016/S0022-3476(98)70229-X

Cited by

  1. Effects of Anti-Inflammatory Drugs on Intravenous Immunoglobulin Therapy in the Acute Phase of Kawasaki Disease vol.36, pp.2, 2013, https://doi.org/10.1007/s00246-014-1010-7
  2. Spontaneous Duodenal Perforation as a Complication of Kawasaki Disease vol.2015, pp.None, 2013, https://doi.org/10.1155/2015/689864
  3. Authors' response to ‘Aspirin dose for treatment of Kawasaki disease’ vol.100, pp.3, 2015, https://doi.org/10.1136/archdischild-2014-307798
  4. High-Dose Aspirin Is Associated with Anemia and Does Not Confer Benefit to Disease Outcomes in Kawasaki Disease vol.10, pp.12, 2015, https://doi.org/10.1371/journal.pone.0144603
  5. Vaccines and Kawasaki disease vol.15, pp.3, 2013, https://doi.org/10.1586/14760584.2016.1128329
  6. C-reactive Protein and Erythrocyte Sedimentation Rate Discrepancies and Variations after Intravenous Immunoglobulin Therapy in Kawasaki Disease vol.23, pp.1, 2013, https://doi.org/10.14776/piv.2016.23.1.25
  7. Aspirin Dose and Prevention of Coronary Abnormalities in Kawasaki Disease vol.139, pp.6, 2013, https://doi.org/10.1542/peds.2017-0098
  8. Kawasaki disease and coronary artery aneurysms: from childhood to adulthood vol.13, pp.5, 2013, https://doi.org/10.2217/fca-2017-0039
  9. Kawasaki disease: a comprehensive review vol.3, pp.None, 2018, https://doi.org/10.5114/amsad.2018.74522
  10. Aspirin Dose in Kawasaki Disease: The Ongoing Battle vol.70, pp.10, 2013, https://doi.org/10.1002/acr.23504
  11. An Update on Treatment of Kawasaki Disease vol.5, pp.1, 2013, https://doi.org/10.1007/s40674-019-00115-z
  12. Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis vol.14, pp.5, 2013, https://doi.org/10.1371/journal.pone.0217274
  13. Aspirin Dose and Treatment Outcomes in Kawasaki Disease: A Historical Control Study in Japan vol.8, pp.None, 2013, https://doi.org/10.3389/fped.2020.00249
  14. What dose of aspirin should be used in the initial treatment of Kawasaki disease? A meta-analysis vol.59, pp.8, 2013, https://doi.org/10.1093/rheumatology/keaa050
  15. The Impact of Moderate-Dose Acetylsalicylic Acid in the Reduction of Inflammatory Cytokine and Prevention of Complication in Acute Phase of Kawasaki Disease: The Benefit of Moderate-Dose Acetylsalicyl vol.7, pp.10, 2020, https://doi.org/10.3390/children7100185
  16. Anti-inflammatory Treatment of Kawasaki Disease: Comparison of Current Guidelines and Perspectives vol.8, pp.None, 2013, https://doi.org/10.3389/fmed.2021.738850
  17. Treatment of Kawasaki Disease: A Network Meta-Analysis of Four Dosage Regimens of Aspirin Combined With Recommended Intravenous Immunoglobulin vol.12, pp.None, 2021, https://doi.org/10.3389/fphar.2021.725126
  18. Low-dose or no aspirin administration in acute-phase Kawasaki disease: a meta-analysis and systematic review vol.106, pp.7, 2013, https://doi.org/10.1136/archdischild-2019-318245
  19. Kawasaki Disease: A Systematic Review and Meta‐Analysis of Benefits and Harms of Common Treatments vol.3, pp.10, 2021, https://doi.org/10.1002/acr2.11308