What is the role of aspirin in the treatment of Kawasaki disease?

Updated: Jul 29, 2018
  • Author: Tina K Sosa, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Aspirin has long been a standard part of therapy for KD. However, its use has been called into question, as it does not impact the development of CAAs. [1]  Although some authors have suggested that aspirin is no longer needed, most experts use medium- to high-dose aspirin for a variable period, followed by lower-dose aspirin.

Medium- (30-50 mg/kg/day) to high- (80-100 mg/kg/day) dose aspirin divided four times daily is typically given in the acute phase for its anti-inflammatory effects. It is continued until day 14 of the illness or until the patient has been afebrile for 48-72 hours.

Once the patient has remained afebrile for 48-72 hours, low-dose aspirin is often initiated for its antiplatelet activity. The dose is 3-5 mg/kg/day for a total of 6-8 weeks as long as the patient shows no evidence of coronary abnormalities. For patients who have aneurysms, aspirin is commonly continued until the aneurysm resolves or is continued indefinitely.

Randomized controlled trial outcomes are insufficient to indicate whether children with this disorder should continue to receive aspirin as part of the treatment regimen. [76] Baumer et al concluded that no randomized clinical trials of adequate quality have been performed and that current evidence is insufficient to support or refute the use of aspirin in children with KD as part of their treatment regimen. [77]

Patients who remain on long-term, low-dose aspirin should receive an annual influenza vaccine and be vaccinated against varicella. Additionally, the risks of developing Reye syndrome during an active infection with influenza or varicella should be addressed. Clopidogrel (Plavix) may be briefly substituted for aspirin in patients who develop influenza or varicella. This agent can also be used in patients allergic to aspirin. [9]  Patients on prolonged aspirin therapy must also be instructed that concomitant use of ibuprofen antagonizes the irreversible effect of platelet inhibition by aspirin and should be avoided during therapy.

The pediatrician or cardiologist who provides the long-term care should monitor aspirin therapy and decide whether to use additional anticoagulative medications, including warfarin or heparin.


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