From the Guidelines
Aspirin therapy in Kawasaki disease should be continued for 6-8 weeks with low-dose aspirin (3-5 mg/kg/day) if no coronary artery abnormalities are detected, but indefinitely if coronary abnormalities develop, as recommended by the most recent guidelines 1. The treatment of Kawasaki disease typically involves high-dose aspirin (80-100 mg/kg/day divided into four doses) during the acute febrile phase, followed by low-dose aspirin after fever resolution.
- The initial high-dose aspirin helps reduce inflammation and fever,
- while the subsequent low-dose aspirin prevents platelet aggregation and potential thrombosis in the coronary arteries. The duration of aspirin therapy depends on the presence of coronary artery abnormalities, which are assessed through regular cardiac monitoring with echocardiography.
- If no coronary artery abnormalities are detected, low-dose aspirin is continued for 6-8 weeks after the onset of illness, as stated in the guidelines 1.
- However, if coronary artery abnormalities develop, aspirin therapy should be continued indefinitely or until the abnormalities resolve, to prevent thrombosis and potential long-term complications. It is essential to note that the concomitant use of ibuprofen antagonizes the irreversible platelet inhibition induced by aspirin, and therefore, ibuprofen should be avoided in children with coronary artery aneurysms taking aspirin for its antiplatelet effects 1. Regular follow-up and monitoring are crucial to determine the appropriate duration of aspirin therapy and to minimize the risk of potential complications, such as Reye syndrome, which is a rare but serious condition associated with aspirin use in children with viral infections 1.
From the Research
Aspirin Therapy in Kawasaki Disease
The duration of aspirin therapy in patients with Kawasaki disease is a topic of ongoing research and debate.
- The optimal dose and duration of aspirin therapy are not well established, with different studies suggesting varying durations and doses 2, 3, 4, 5.
- A study from 1990 compared high-dose (100 mg/kg/day) and low-dose (30 mg/kg/day) aspirin therapy and found that high-dose aspirin shortened the duration of fever but did not confer any additional benefits in terms of coronary artery lesions 4.
- Another study from 2015 found that high-dose aspirin was associated with anemia and did not provide any benefits in terms of disease outcomes 3.
- A 2013 study suggested that high-dose aspirin may not be necessary in the acute phase of Kawasaki disease, as it did not improve outcomes or reduce the incidence of coronary artery lesions 5.
- The use of aspirin in combination with other treatments, such as intravenous immunoglobulin (IVIG) and corticosteroids, is also being investigated, with some studies suggesting that the addition of corticosteroids may reduce the incidence of coronary aneurysms 6.
Duration of Aspirin Therapy
- The duration of aspirin therapy in Kawasaki disease is typically several weeks, with some studies suggesting that low-dose aspirin should be continued for 6-8 weeks after the onset of illness 2, 3.
- However, the optimal duration of aspirin therapy is not well established and may vary depending on the individual patient and the specific treatment regimen.
- Further research is needed to determine the optimal dose and duration of aspirin therapy in Kawasaki disease, as well as the potential benefits and risks of different treatment regimens 2, 3, 4, 5.