Rheumatology Xagena

Kawasaki disease: high-dose Aspirin is associated with anemia and does not confer benefit to disease outcomes

Kawasaki disease ( KD ) is also known as multiple mucocutaneous lymph node syndrome of systemic vasculitis and is a leading cause of coronary artery lesions ( CAL ) in childhood.
Intravenous immunoglobulin ( IVIG ) has been proven to effectively reduce the incidence of coronary artery lesions, but the role and effect dose of Aspirin [ Acetylsalicylic acid ] in Kawasaki disease is still unclear.
Moreover, overt bleeding and anemia are associated with the use of Aspirin, and anemia is common in patients with Kawasaki disease.

The aim of a study was conducted to compare the treatment efficacy, degree of anemia and inflammation, and changes in serum hepcidin in children who received a combination of high-dose Aspirin and IVIG in the acute stage of Kawasaki disease, and those who received IVIG alone.

Patients with Kawasaki disease from two medical centers were retrospectively analyzed from 1999-2009.

All patients were initially treated with a single dose of IVIG ( 2 g/kg ) as the standard care of treatment.
In group 1, high-dose Aspirin was prescribed ( more than 30 mg/kg/day ) until the fever subsided, and then low-dose Aspirin ( 3-5 mg/kg/day ) was prescribed until all the inflammation signs had resolved.
In group 2, low-dose Aspirin was prescribed without high-dose Aspirin.

A total of 851 patients with Kawasaki disease ( group 1, N = 305, group 2, N = 546 ) were enrolled in this study. There were no significant differences between group 1 and group 2 in terms of gender ( p = 0.51 ), IVIG resistance rate ( 31/305 vs 38/546, p = 0.07 ), coronary artery lesions formation ( 52/305 vs. 84/546, p = 0.67 ), and duration of hospitalization ( 6.3 ± 0.2 vs. 6.7 ± 0.2 days, p = 0.13 ).
There were also initially no significant differences in total white blood cell count, hemoglobin level, platelet count, and CRP before IVIG treatment between groups ( all p less than 0.1 ).

After IVIG treatment, group 1 had significantly lower levels of hemoglobin ( p = 0.006 ) and higher CRP ( p less than 0.001 ) as well as a smaller decrease in CRP level ( p = 0.012 ).

Furthermore, there was also a higher serum level of hepcidin and a delayed decrease in hepcidin level after receiving IVIG in group 1 ( p = 0.04 and 0.02, respectively ).

In conclusion, these results provide evidence demonstrating that high-dose Aspirin in the acute phase of Kawasaki disease does not confer any benefit with regards to inflammation and it does not appear to improve treatment outcomes.
Therefore, high-dose Aspirin is unnecessary in acute phase Kawasaki disease. ( Xagena )

Kuo HC et al, PLoS One 2015;10(12):e0144603. doi: 10.1371/journal.pone.0144603. eCollection 2015.