Abstract 148: The Optimal Duration Of Asa Treatment After Acute Phase Of Kawasaki Disease Based On Inflammatory Markers

Abstract

Purpose: Outcomes of Kawasaki disease (KD) are determined by the development of cardiovascular complications. Low dose aspirin(ASA) treatment is used as antithrombotic effect after acute phase of KD for 6-8 weeks.There are no standardized inflammatory markers used as guidance for completing low dose ASA treatment. The optimal duration of low dose ASA treatment is not determined. The aim of this study is to decide the duration of low dose ASA treatment based on inflammatory markers. Methods : We enrolled 80 KD children admitted to the Chungnam National University Hospital,South Korea between Sep 2012 and May 2014. We reviewed the medical records for clinical characteristics, duration of fever, cardiovascular complications and laboratory data on admission. Inflammatory markers were measured every 7-14 days at OPD after immunoglobulin(IVIG) and high dose ASA treatment in acute phase. Low dose ASA was stopped when the level of inflammatory markers were down to the normal without any cardiovascular complications. Echocardiograms were performed at admission, discharge and prior to completion of ASA treatment when the inflammatory marker turned to normal. Results : 80 KD patients,(Complete, n=44; Incomplete, n=36). The incidence of cardiovascular complications was similar both two groups. No significant differences in the laboratory studies either complete or incomplete KD. The levels of inflammatory marker were normalize after the acute phase as 13.0±13.6 days for platelets, 13.8± 8.3 days for CRP, 14.4±9.6 days for d-dimer, and 24.1 ± 10.5 days for ESR. The levels of platelets and CRP were first normalized within 2 weeks, and that of ESR was last within 3-4 weeks. The duration of raised CRP levels showed significantly shorter in incomplete group compared to complete groups (p=0.02). No new coronary lesions were developed among patients who didn’t have the coronary lesions at subacute phase. Conclusion: The majority of the inflammatory marker levels were normalized within 2-3 weeks after acute phase of KD. There were no new cardiovascular complications when the duration of low dose ASA treatment was guided by level of the inflammatory markers. So, the optimal duration of low dose ASA treatment can be reduced to 3-4 weeks without development of coronary lesions.