Background/Purpose: Kawasaki disease (KD) is generally treated with intravenous immunoglobulin (IVIG) together with high anti-inflammatory doses of acetyl salicylic acid (ASA), which is subsequently switched to low, anti-thrombotic dose ASA. However, there is still no evidence whether adding high dose ASA to IVIG increases the efficacy of the latter, especially concerning coronary artery outcome. We aimed to compare the efficacy and safety of IVIG+ anti-inflammatory high dose ASA regimen to IVIG with low dose ASA in a multicenter, national, retrospective study.

Methods: Medical record review of KD patients from our Pediatric Rheumatology Study Group units was conducted. Some hospitals do not use anti-inflammatory high dose ASA routinely, but rather add low dose ASA therapy to IVIG. Demographic data, clinical manifestations, coronary involvement, ASA and IVIG doses and adverse events were recorded. The primary efficacy outcome was defined as coronary aneurism 2-4 weeks after fever onset. Secondary outcomes were time from beginning of therapy to fever resolution and disease recurrence (defined as recurrence of fever after >72 hours). High dose and low dose ASA groups were compared using the Student’s t-test for continuous variables and the Pearson Chi-square test for categorical variables.

Results: 336 KD patients, 287 in the high dose ASA group and 49 in the low dose ASA group were included. There were no demographic, clinical, or laboratory differences between the groups. In the high dose ASA group, 8% had coronary aneurisms, while no aneurisms were reported in the low dose ASA group (P<0.2). Regarding mild coronary findings, 22.8% of the  high dose ASA group developed coronary ectasia 2-4 weeks after KD onset, compared to 3.6% in the  low dose ASA group (p<0.02). No significant statistical differences were noted between the groups in time until fever resolution in days (high dose ASA 0.77±1.84; low dose ASA 1.1±3.34; P=0.34) or in KD recurrence (high dose ASA 32/287 (11%); low dose ASA 7/49 (14%); P=0.58). The need for use of rescue medications was similar in both groups. The number of adverse events in both groups were similar (P=0.86).

Conclusion: The efficacy and safety of treatment with IVIG and low-dose ASA was similar to that of IVIG and high dose ASA in patients with KD. We suggest that the routine use of high-dose ASA in addition to IVIG, will be re-evaluated in a prospective controlled study.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-dose-aspirin-for-treating-kawasaki-disease-outdated-myth-or-effective-aid/