Abstract
Background: Kawasaki Disease (KD) has potentially serious cardiac complications including coronary artery aneurysms. Giant aneurysms (GAs) (diameter 0.8cm) increase the risk of thrombosis, and to reduce the ischemic risks, anticoagulation with warfarin is recommended, but its efficacy has not been studied. Hypothesis: Anticoagulation alters the outcome of patients with GAs. Objectives: To determine 1) If anticoagulation is cardioprotective for myocardial ischemia 2) Whether anticoagulation affects the size of GAs. Method: A retrospective cohort study of all KD patients who had a 2D echo at the Hospital for Sick Children between 05/90 and 04/00 were performed. Results: Twenty-two of 997 patients (2.2%) had GAs. Patients were divided into two groups: 1) Therapeutic anticoagulation with warfarin (with or without antiplatelet agents); 2) No anticoagulation (with or without antiplatelet agents). There were no significant demographic differences between the groups for sex distribution (11M:2F and 7M:2F), and age at diagnosis (5.2 vs. 3.8 yr). Mean duration of follow-up was significantly longer for the no anticoagulation group (6.9 vs. 13.3 yr, p=0.008) In the anticoagulation group, there were 22 GAs (1.7/pt), and 20 non-giant aneurysms (>0.4 cm <0.8 cm) (1.5/pt). In the no anticoagulation group there were 17 GAs (1.9/pt) and 13 non-giant aneurysms (1.4/pt). These numbers were not significantly different. Early ischemic events (<1 year) occurred in four patients: two patients had MIs on warfarin, one patient had an MI on no anticoagulation, and one patient had a coronary thrombosis and stroke at presentation with KD. Late ischemic events were monitored by stress thallium or sestamibi scanning. Of four patients in the anticoagulation group followed by scanning, at mean f/u 82 months there were no perfusion defects noted. In the anticoagulation group, at 126 months, only 1/9 patients had reversible defects, subsequently requiring CABG surgery. Regression of aneurysms (GAs and non-giant) was observed in both groups. GAs regressed a mean 22% vs 32% (p=0.24), and non-giant aneurysms regressed a mean of 28% vs 25% (p=0.74). Compliance with anticoagulation was good, with INRs in range 52% of the time. There were no major bleeding complications of anticoagulation, but most patients had minor bleeding (epistaxis, bruising). Conclusions: Early ischemic events occurred independent of anticoagulation, and late ischemic changes were rare. Regression of GAs was observed regardless of anticoagulation. No benefit for long-term anticoagulation was observed, but long term follow-up studies are needed to further evaluate the potential benefits of anticoagulation vs. its potential serious complications.
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Miller, D., McCrindle, B. & Yeung, R. Giant Aneurysms in Kawasaki Disease: Is Outcome Affected by Anticoagulation?. Pediatr Res 53, 185 (2003). https://doi.org/10.1203/00006450-200301000-00190
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DOI: https://doi.org/10.1203/00006450-200301000-00190