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AIMS Allergy and Immunology

2025, Volume 9, Issue 3: 156-165. doi: 10.3934/Allergy.2025012
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Efficacy of halfdose aspirin in Kawasaki disease: Insights from a single center experience

  • Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
  • Published: 01 July 2025
  • Background 

    Long-term oral aspirin (Asp) therapy poses challenges in children with Kawasaki Disease (KD) complicated by coronary artery aneurysms (CAA), especially when frequent epistaxis is present.

    Objective 

    This study seeks to evaluate the efficacy and safety of a reduced-dose aspirin regimen for an antiplatelet therapy during the subacute and convalescent phases of KD.

    Methods 

    This retrospective study included 554 pediatric KD patients (350 males, 204 females; median age: 2.5 years). The patients were divided into two groups based on their aspirin dosage initiated one week after fever subsidence: The observation group (OG, n = 253) received low-dose Asp (1.5–2.5 mg/kg/day), while the control group (Ctrl, n = 301) received standard-dose Asp (3–5 mg/kg/day).

    Results 

    The incidence of bleeding was significantly lower in the OG compared to the Ctrl group (p < 0.05). In both groups, the coronary thrombi either shrank or resolved after one year following alteplase therapy, provided that the international normalized ratio (INR) was maintained at 2.0–3.0 and arachidonic acid (AA) inhibition remained below 20%, with no significant intergroup difference (p > 0.05). Aspirin resistance (AR) was observed in 17 OG patients, which resolved after increasing the Asp dose to 3–5 mg/kg/day for one week. Mural thrombosis occurred in six patients (3 per group), none of whom had AR.

    Conclusion 

    Reducing aspirin to a half-dose regimen after intravenous immunoglobulin (IVIG) treatment in the subacute and recovery phases of KD is both safe and effective, thereby significantly lowering the risk of bleeding without compromising the antithrombotic efficacy.

    Citation: Huaxu Shi, Yanqiu Chu, Xuexin Yu, Jinghao Li, Hong Wang, Yunming Xu. Efficacy of halfdose aspirin in Kawasaki disease: Insights from a single center experience[J]. AIMS Allergy and Immunology, 2025, 9(3): 156-165. doi: 10.3934/Allergy.2025012

    Related Papers:

  • Background 

    Long-term oral aspirin (Asp) therapy poses challenges in children with Kawasaki Disease (KD) complicated by coronary artery aneurysms (CAA), especially when frequent epistaxis is present.

    Objective 

    This study seeks to evaluate the efficacy and safety of a reduced-dose aspirin regimen for an antiplatelet therapy during the subacute and convalescent phases of KD.

    Methods 

    This retrospective study included 554 pediatric KD patients (350 males, 204 females; median age: 2.5 years). The patients were divided into two groups based on their aspirin dosage initiated one week after fever subsidence: The observation group (OG, n = 253) received low-dose Asp (1.5–2.5 mg/kg/day), while the control group (Ctrl, n = 301) received standard-dose Asp (3–5 mg/kg/day).

    Results 

    The incidence of bleeding was significantly lower in the OG compared to the Ctrl group (p < 0.05). In both groups, the coronary thrombi either shrank or resolved after one year following alteplase therapy, provided that the international normalized ratio (INR) was maintained at 2.0–3.0 and arachidonic acid (AA) inhibition remained below 20%, with no significant intergroup difference (p > 0.05). Aspirin resistance (AR) was observed in 17 OG patients, which resolved after increasing the Asp dose to 3–5 mg/kg/day for one week. Mural thrombosis occurred in six patients (3 per group), none of whom had AR.

    Conclusion 

    Reducing aspirin to a half-dose regimen after intravenous immunoglobulin (IVIG) treatment in the subacute and recovery phases of KD is both safe and effective, thereby significantly lowering the risk of bleeding without compromising the antithrombotic efficacy.


    Abbreviations

    Asp

    Aspirin

         A.A.

    Arachidonic acid

         AHA

    American Heart Association

         ADP

    Adenosine diphosphate

         AR

    Aspirin resistance

         CAL

    Coronary artery lesions

         CAA

    Coronary artery aneurysm

         CAN

    Normal Coronary artery

         COX

    Cyclooxygenase

         CTCA

    CT coronary angiography

         CAAT

    Thrombus in coronary artery aneurysm

         CMR

    Cardiovascular magnetic resonance

         IVIG-R

    Intravenous immunoglobulin resistance

         INR

    International normalized ratio

         ECHO

    Echocardiography

         GCs

    Glucocorticoids

         IKD

    Incomplete Kawasaki disease

         KD

    Kawasaki disease

         LM

    Left main coronary artery

         LAD

    Left anterior descending branch

         LVED

    Left ventricular end-diastolic diameter

         LVEF

    Left ventricular injection fraction

         RCA

    Right coronary artery

         TXA2

    Thromboxane A2
    加载中


    Conflict of interest


    The authors declare no conflict of interest.

    Author contributions


    H.S.: Data collection, analysis, and editing of the draft of the thesis; Y.C., X.Y., and J.L.: Diagnosis, treatment and follow-up of some patients; H.W.: The design of this project, ethical application; diagnosis, treatment and follow-up of vast majority of patients, the editing of the preface, conclusion and discussion sections of the manuscript; Y.X.: Data, analysis; diagnosis, treatment and follow-up of some patients; editing of the manuscript discussion section and supplementation of references.

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  • © 2025 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
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