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Aspirin Dose and Prevention of Coronary Abnormalities in Kawasaki Disease
Frederic Dallaire1, Zoe Fortier-Morissette2, Samuel Blais2
1Department of Pediatrics, Faculty of Medicine and Health Sciences, Centre de recherche du centre hospitalier universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada; frederic.a.dallaire@usherbrooke.ca.
Insights
Low-dose aspirin (ASA) is as effective as high-dose ASA in preventing coronary artery abnormalities in children with Kawasaki disease (KD) when given with immunoglobulin. This finding supports using lower ASA doses for KD treatment.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Pharmacology
Background:
- Kawasaki disease (KD) treatment guidelines recommend acetylsalicylic acid (ASA).
- Optimal ASA dosage for KD remains debated.
- Preventing coronary artery (CA) abnormalities is a key treatment goal.
Purpose of the Study:
- To evaluate the noninferiority of low-dose ASA compared to high-dose ASA in preventing CA abnormalities in acute KD.
- To determine if antiplatelet doses of ASA are sufficient for managing KD.
Main Methods:
- Multicenter, retrospective, nonrandomized cohort study (2004-2015).
- Included children aged 0-10 years with acute KD.
- Compared outcomes between institutions using low-dose (3-5 mg/kg/day) vs. high-dose (80 mg/kg/day) ASA, alongside intravenous immunoglobulin.
Main Results:
- 1213 patients included: 365 low-dose ASA, 848 high-dose ASA.
- No significant difference in CA abnormalities between low-dose (22.2%) and high-dose (20.5%) ASA groups.
- Adjusted risk difference for CA abnormalities was within the noninferiority margin (-4.5% to 5.0%).
Conclusions:
- Low-dose ASA is noninferior to high-dose ASA in preventing CA abnormalities in acute KD when used with intravenous immunoglobulin.
- Findings suggest lower ASA doses may be a safe and effective option for KD treatment.
- This study contributes to optimizing KD management strategies.
Background:
Acetylsalicylic acid (ASA) is part of the recommended treatment of Kawasaki disease (KD). Controversies remain regarding the optimal dose of ASA to be used. We aimed to evaluate the noninferiority of ASA at an antiplatelet dose in acute KD in preventing coronary artery (CA) abnormalities.
Methods:
This is a multicenter, retrospective, nonrandomized cohort study including children 0 to 10 years of age with acute KD between 2004 and 2015 from 5 institutions, of which 2 routinely use low-dose ASA (3-5 mg/kg per day) and 3 use high-dose ASA (80 mg/kg per day). Outcomes were CA abnormalities defined as a CA diameter with a z score ≥2.5. We assessed the risk difference of CA abnormalities according to ASA dose. All subjects received ASA and intravenous immunoglobulin within 10 days of fever onset.
Results:
There were 1213 subjects included, 848 in the high-dose and 365 in the low-dose ASA group. There was no difference in the risk of CA abnormalities in the low-dose compared with the high-dose ASA group (22.2% vs 20.5%). The risk difference adjusted for potential confounders was 0.3% (95% confidence interval [CI]: -4.5% to 5.0%). The adjusted risk difference for CA abnormalities persisting at the 6-week follow-up was -1.9% (95% CI: -5.3% to 1.5%). The 95% CI of the risk difference of CA abnormalities adjusted for confounders was within the prespecified 5% margin considered to be noninferior.
Conclusions:
In conjunction with intravenous immunoglobulin, low-dose ASA in acute KD is not inferior to high-dose ASA for reducing the risk of CA abnormalities.
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