Is aspirin necessary in the acute phase of Kawasaki disease?

Huang, Xijing; Huang, Ping; Zhang, Li; Xie, Xiaofei; Xia, Shuliang; Gong, Fang; Yuan, Jia; Jin, Liling

doi:10.1111/jpc.13816

Cited by 19 publications

(23 citation statements)

References 22 publications

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“…However, 25 articles were excluded by reading the complete articles due to article type (n = 7), not using the standard IVIG dose (2 g·kg -1 ) during the initial treatment (n = 13), and lacking a low-dose aspirin (3–5 mg·kg -1 ·d -1 ) group for the initial treatment of KD (n = 5). Ultimately, six English reports [20–22,25,28,29] were included in the meta-analysis, while no Chinese reports met the inclusion criteria. The process of study selection was illustrated in Fig 1.…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of the involved patients in all included studies were presented in Table 1. The six published reports [20–22,25,28,29] enrolled a total of 11,103 children, of which were 1,753 low-dose aspirin cases. Six studies that were included came from five countries.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies [28,29] did not specify a criteria for dividing patients into a low-dose or high-dose aspirin group, three studies [20–22] grouped patients by different centers, and one study [25] chose different doses of aspirin depending on the inflammatory level and doctors’ opinions. Furthermore, three studies [21,28,29] did not mention the diagnostic criteria for KD, while another three reports [20,22,25] used the AHA diagnostic criteria [1]. Moreover, one study [28] scored NOS five stars and was considered to be moderate quality, while the other five reports were awarded ≥ six stars and qualified as high quality.…”

Section: Resultsmentioning

confidence: 99%

“…Secondary outcomes included rKD, days of hospital or fever, and adverse events. The potential adverse events for aspirin were allergies, digestive symptoms (diarrhea, vomiting and gastric ulcer), abnormal liver function and hemorrhage (skin petechia, epistaxis) [25].…”

Section: Methodsmentioning

confidence: 99%

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Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis

et al. 2019

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Background Kawasaki disease (KD) is now the leading cause of acquired heart disease in children in developed countries. Intravenous immunoglobulin (IVIG) and aspirin were considered as the standard initial treatment of KD for decades. However, the optimal dose of aspirin has remained controversial. In recent years, many studies compared the efficacy of low-dose with high-dose aspirin in the acute phase of KD, but the results have not always been consistent. Therefore, we performed this meta-analysis to evaluate the efficacy of low-dose aspirin compared with high-dose for the initial treatment of KD. Methods Studies related to aspirin therapy for KD were selected from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Google scholar through Mar 25 th , 2019. Data were analyzed using STATA Version 15.1. Additionally, publication bias and sensitivity analysis were also performed by STATA version 15.1. Results Six studies were included in our analysis of the rate of coronary artery lesion (CAL), five reports for IVIG-resistant KD (rKD), and four for the duration of fever and hospitalization. However, no significant differences were found between low-dose and high-dose aspirin groups in the incidence of CAL (risk ratio (RR), 0.85; 95%CI (0.63, 1.14); P = 0.28), the risk of rKD (RR, 1.39; 95%CI (1.00, 1.93); P = 0.05), and duration of fever and hospitalization (the mean standard deviation (SMD), 0.03; 95%CI (-0.16, 0.22); P = 0.78). Conclusion Low-dose aspirin (3–5 mg·kg -1 ·d -1 ) may be as effective as the use of high-dose aspirin (≥30 mg·kg -1 ·d -1 ) for the initial treatment of KD. Further well-designed randomized clinical trials are needed to evaluate the efficacy of low-dose aspirin for the initial treatment of KD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis

et al. 2019

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“…This choice did not affect the cardiac outcome in our cohort as already stated by literature. In fact, although ASA has important anti-inflammatory activity (at high doses) and antiplatelet activity (at low doses), it does not appear to lower the frequency of development of coronary abnormalities [36,37].…”

Section: Kdmentioning

confidence: 99%

Kawasaki Disease In Infants Less Than One Year Of Age: An Italian Cohort From A Single Center

Mastrangelo

Cimaz

Calabri

et al. 2019

Preprint

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Background and aims Few data are currently available for Kawasaki disease (KD) below 12 months especially in Caucasians. This study aims to analyze clinical and laboratory features of KD among an Italian cohort of infants. Methods A retrospective chart review of KD children aged less than one year at time of disease onset between January 2008-December 2017 was performed. Clinical data, laboratory parameters, instrumental findings, treatment and outcome were collected in a customized database. Results Among 113 KD patients, 32 (28.3%) were younger than 1 year. Nineteen patients aged below 6 months, and three below 3 months. The median age was 5.7 ±2.7 months. The mean time to diagnosis was 7±3 days and was longer in the incomplete forms (8 ± 4 vs 6 ± 1 days). Conjunctival injection was present in 26 patients (81.2%); rash in 25 (78.1%); extremity changes in 18 (56.2%); mucosal changes in 13 (40.6%,) and lymphadenopathy only in 7 (21.8%). Mucosal changes were the least common features in incomplete forms (18.2%). Twenty-two patients (68.7%) had incomplete KD. Nineteen (59.4%) had cardiac involvement, of whom 13 (59.0%) had incomplete form. ESR, PCR and platelet values were higher in complete KD; especially, ESR resulted significantly higher in complete forms (80 ± 25.7 mm/h vs 50 ± 28.6 mm/h; p = 0.01). Conversely, AST level was statistically significant higher in patients with incomplete forms (95.4 ± 132.7 UI/L vs 29.8 ± 13.2 UI/L; p = 0.03). All patients received IVIG. Response was reported in 26/32 patients; 6 cases needed a second dose of IVIG and one required a dose of anakinra. Conclusion In our cohort, incomplete disease was commonly found, resulting in delayed diagnoses and poor cardiac prognosis. Infants with incomplete KD seem to have a more severe disease and a greater predilection for coronary involvement than those with complete KD. AST was significantly higher in incomplete forms, thus AST levels might be a new finding in incomplete forms’ diagnosis. Eventually, we highlight a higher resistance to IVIG treatment. To our knowledge this is the first study involving an Italian cohort of patients with KD below 12 months.

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Kawasaki Disease: A Systematic Review and Meta‐Analysis of Benefits and Harms of Common Treatments

James

Kalot

Husainat

et al. 2021

ACR Open Rheumatology

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Objective Kawasaki disease (KD) is a self‐limited vasculitis affecting medium‐sized vessels with a predilection for the coronary arteries. Although treatment reduces the likelihood of developing of coronary artery aneurysms, 5% of patients still develop aneurysms despite treatment, making KD the leading cause of acquired heart disease in children in the United States. Consequently, there is a great deal of interest in optimizing treatment regimens, particularly for higher‐risk patients, to decrease morbidity. The aim of this systematic review is to support the development of the American College of Rheumatology/Vasculitis Foundation for the diagnosis and management of KD, focusing on the more complex scenarios in which rheumatologists may become involved, such as high‐risk and refractory disease. Methods Eighty‐nine articles were considered for full review in this systematic literature review to address 16 Population, Intervention, Comparison, and Outcome questions related to KD. Data were abstracted in hierarchical fashion. Randomized control trials (RCTs) were considered first; if none were identified or if they contained insufficient information, comparative observational studies were then viewed, followed by single‐arm observational studies/single arms from comparative studies. Only observational studies with more than 10 subjects with vasculitis were included. Results Eight RCTs and 28 observational studies that addressed the questions were identified. Two questions were addressed by RCTs, seven questions had at least some comparative observational studies, three questions were only addressed by single‐arm data, and four questions had no relevant studies. Conclusion This systematic review evaluates the benefits and harms of treatments for KD beyond first‐line therapy.

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Is aspirin necessary in the acute phase of Kawasaki disease?

Abstract: The role of aspirin in the treatment of the acute phase of KD should be questioned as a definite benefit has not been shown in our study. Further prospective studies incorporating large multicentre samples of patients are needed to confirm this finding.

Cited by 19 publications

References 22 publications

Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis

Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis

Kawasaki Disease In Infants Less Than One Year Of Age: An Italian Cohort From A Single Center

Kawasaki Disease: A Systematic Review and Meta‐Analysis of Benefits and Harms of Common Treatments

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