High-Versus Low-Dose Aspirin in the Treatment of Kawasaki Disease

Abstract

Research Article| April 01 2020 High-Versus Low-Dose Aspirin in the Treatment of Kawasaki Disease AAP Grand Rounds (2020) 43 (4): 44. https://doi.org/10.1542/gr.43-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation High-Versus Low-Dose Aspirin in the Treatment of Kawasaki Disease. AAP Grand Rounds April 2020; 43 (4): 44. https://doi.org/10.1542/gr.43-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: aspirin low dose, fever, immunoglobulins, intravenous, kawasaki's disease Source: Platt B, Belarski E, Manaloor J, et al. Comparison of risk of recrudescent fever in children with Kawasaki disease treated with intravenous immunoglobulin and low-dose vs high-dose aspirin. JAMA Netw Open. 2020; 3(1): e1918565; doi: https://doi.org/10.1001/jamanetworkopen.2019.18565Google Scholar Investigators from Indiana University, Indianapolis, IN, conducted a retrospective study to compare rates of recrudescent fever and coronary artery (CA) abnormalities in children treated with IV immunoglobulin (IVIG) and either low- or high-dose aspirin (ASA) for treatment of Kawasaki disease (KD). Study participants were children with KD treated within 10 days of symptom onset with 2 g/kg of IVIG and ASA at Riley’s Hospital for Children, Indianapolis, IN, between 2007 and 2018. Eligible children were identified using ICD-9 and ICD-10 codes; the medical records of eligible children were reviewed, and information was abstracted on demographics, symptoms before admission, clinical course during hospitalization and follow-up, echocardiography results, and dose of ASA. Initial ASA doses were categorized as low (<10 mg/kg/d) or high (>10 mg/kg/d). The primary outcome was recrudescent fever, defined as a rectal temperature >38.0°C or axillary temperature >37.5°C within 14 days of initial treatment that necessitated retreatment. Secondary outcomes were development of CA abnormalities and length of initial hospital stay. Outcomes in children treated with low- or high-dose ASA were compared using regression analyses after controlling for confounding variables. Subgroup analyses, limited to study patients with complete KD, also were conducted. Data were analyzed in 260 children with a median age of 2.5 years. There were 142 patients treated with low-dose ASA (median dose, 4.4 mg/kg/d), and 118 received high-dose ASA (median dose, 75.5 mg/kg/d). Most of the children in the low-dose group were treated before 2016, whereas most of those receiving high-dose ASA were treated after 2015. The 2 groups were similar for most other characteristics except that the percentage of children with incomplete KD was significantly higher among those in the high-dose group (44.1% vs 28.9% for those in the low-dose group; P = .01). Among those receiving low-dose ASA, the rate of recrudescent fever was 27.5% versus 26.0% in those receiving high-dose ASA. After adjusting for age <1 year and incomplete KD, the OR for recrudescent fever was 1.63 (95% CI, 0.89–2.97). Among the 167 study children with complete KD, the OR for recrudescent fever was 1.87 (95% CI, 0.82–4.23), when comparing the low- to high-dose groups. There was also no significant difference in rates of CA abnormalities between children in the low- and high-dose groups (7.4% and 9.4%, respectively; OR, 1.02; 95% CI, 0.55–1.87). The median length of hospital stay was 3 days for both groups (P = .27). The authors conclude that there was no difference in rates of recrudescent fever or CA abnormalities among children with KD treated with IVIG and either low- or high-dose ASA. Dr Spar has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.... You do not currently have access to this content.