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Aspirin Dose in Kawasaki Disease: The Ongoing Battle
Author(s) -
Dhanrajani Anita,
Chan Mercedes,
Pau Stephanie,
Ellsworth Janet,
Petty Ross,
Guzman Jaime
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23504
Subject(s) - medicine , kawasaki disease , aspirin , incidence (geometry) , confidence interval , odds ratio , coronary artery aneurysm , coronary artery disease , dosing , vasculitis , gastroenterology , artery , surgery , disease , physics , optics
Objective Kawasaki disease ( KD ) is an acute childhood vasculitis that may result in coronary aneurysms. Treatment of KD with a single infusion of 2 gm/kg intravenous immunoglobulin ( IVIG ) is well established, but acetylsalicylic acid ( ASA ) dose remains controversial. Our primary objective was to determine the difference in the incidence of IVIG resistance between 2 ASA doses. Our secondary objective was to compare the duration of hospital stay and the incidence of coronary artery aneurysm. Methods We reviewed charts of patients with KD from 2 Canadian centers to assess the impact of ASA dose on IVIG resistance (operationally defined as administration of a second dose of IVIG ). Both centers used standard IVIG dosing, but center 1 used low‐dose ASA from diagnosis (3–5 mg/kg/day) while center 2 used initial high‐dose ASA (80–100 mg/kg/day). Results There were no significant differences in baseline characteristics between the 2 centers. Retreatment with a second dose of IVIG was required in 28 of 122 patients (23%) treated with low‐dose ASA , and in 11 of 127 patients (8.7%) treated with high‐dose ASA in center 1 and center 2, respectively ( P = 0.003). After adjusting for confounders, low‐dose ASA was associated with higher odds of IVIG resistance ( OR 3.2 [95% confidence interval 1.1, 9.1]). The mean duration of hospital stay was 4.1 and 4.7 days, respectively ( P = 0.37). Coronary artery aneurysms were seen in 2 of 117 and 6 of 125 patients from centers 1 and 2, respectively ( P = 0.28). Conclusion Low‐dose ASA was associated with 3‐times higher odds of IVIG retreatment compared to high‐dose ASA , with no significant difference in duration of hospital stay or incidence of coronary artery aneurysms.