Aspirin for Kawasaki Disease: High or Low Dose?

Summary and Comment |
May 8, 2017

Aspirin for Kawasaki Disease: High or Low Dose?

  1. Deborah Lehman, MD

Coronary artery abnormalities occurred at the same rate in children treated with high or low doses of aspirin.

  1. Deborah Lehman, MD

Treatment with intravenous immunoglobulin (IVIG) and aspirin is effective for reducing risk for cardiac complications of Kawasaki disease. Although the dose of IVIG is standardized at 2 g/kg, the appropriate dose of aspirin has been debated. Some centers use an anti-inflammatory dose (80–100 mg/kg/day) during the acute illness, and others a much lower antithrombotic dose (3–5 mg/kg/day). Previous studies do not demonstrate a relationship between aspirin dose and the risk for coronary artery abnormalities.

In the current retrospective, nonrandomized cohort study, researchers in Canada compared the risk for coronary artery abnormalities in 1213 children aged ≤10 years who received treatment for Kawasaki disease at centers routinely prescribing low-dose aspirin (<10 mg/kg/day; 365 patients) or at centers prescribing high-dose aspirin (≥10 mg/kg/day [dose was >79 mg/kg/day in 99%]; 848 patients).

Coronary artery abnormalities were detected in 255 children (21%), and of these, 157 (13%) had persistent abnormalities at 6-week follow-up. No difference in the occurrence of coronary artery abnormalities was seen between the high-dose group (13.2%) and the low-dose group (12.3%). Approximately one quarter of children required IVIG retreatment, but this was similar between the two groups.

Comment

This study does little to clarify an optimal aspirin dose in the treatment of Kawasaki disease, but supports existing evidence suggesting that dose might not make a difference. The coronary artery abnormality rate of 21%, with persistence in almost 13%, is high in this study, but the dose of aspirin, high or low, did not make a difference.

Editor Disclosures at Time of Publication

  • Disclosures for Deborah Lehman, MD at time of publication Editorial boards NEJM Knowledge+ Leadership positions in professional societies American Academy of Pediatrics; PREP The Course (Planning Committee Member)

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