Paediatric Rheumatology
High-dose aspirin for Kawasaki disease: outdated myth or effective aid?
G. Amarilyo1, Y. Koren2, D. Brik Simon3, M. Bar-Meir4, H. Bahat5, M.H. Helou6, A. Mendelson7, N. Hezkelo8, G. Chodick9, Y. Berkun10, E. Eisenstein11, Y. Butbul Aviel12, G. Barkai13, Y. Bolkier14, S. Padeh15, R. Brik16, P.J. Hashkes17, L. Harel18, Y. Uziel19
- Department of Paediatrics, Schneider Children’s Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
- Department of Paediatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Department of Paediatrics, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel.
- Department of Paediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.
- Department of Paediatrics, Rambam Medical Center, Haifa, Israel.
- Department of Paediatrics, Meir Medical Center, Kfar Saba, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
- Department of Paediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Department of Paediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Department of Paediatrics, Rambam Medical Center, Haifa, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel.
- Department of Paediatrics, Rambam Medical Center, Haifa, Israel.
- Department of Paediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
- Department of Paediatrics, Schneider Children’s Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Meir Medical Center, Kfar Saba, Israel. uziely@zahav.net.il
CER9772
2017 Vol.35, N°1 ,Suppl.103
PI 0209, PF 0212
Paediatric Rheumatology
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PMID: 28079513 [PubMed]
Received: 20/07/2016
Accepted : 10/10/2016
In Press: 05/01/2017
Published: 20/04/2017
Abstract
OBJECTIVES:
To compare the efficacy and safety of intravenous immunoglobulin (IVIG) plus high-dose aspirin (HDA) vs. IVIG plus low-dose aspirin (LDA) for the treatment of Kawasaki disease, with an emphasis on coronary artery outcomes.
METHODS:
This study was a retrospective, medical record review of paediatric patients with Kawasaki disease comparing 6 centres that routinely used HAD for initial treatment and 2 that used LDA in 2004-2013. Treatment response and adverse events were compared. The primary outcome measure was the occurrence of coronary aneurysm at the subacute or convalescent stage.
RESULTS:
The cohort included 358 patients, of whom 315 were initially treated with adjunctive HDA and 43 with LDA. There were no demographic differences between the groups. Coronary aneurysms occurred in 10% (20/196) of the HDA group and 4% (1/24) of the LDA group (p=0.34). Equivalence tests indicate it is unlikely that the risk of coronary aneurysm in LDA exceeds HDA by more than 3.5%. There were no significant between-group differences in the need for glucocorticoid pulse therapy or disease recurrence. Coronary ectasia rate and hospitalisation time were significantly greater in the HDA group. Adverse events were similar in the two groups.
CONCLUSIONS:
We found no significant clinical benefit in using IVIG+HDA in Kawasaki disease compared to IVIG+LDA. The use of adjunctive HDA in this setting should be reconsidered.
