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What dose of aspirin should be used in the initial treatment of Kawasaki disease?
  1. Luke Guo Yang Ho1,2,
  2. Nigel Curtis2
  1. 1Monash School of Medicine, Monash University, Clayton, Victoria, Australia
  2. 2Department of Paediatrics, The University of Melbourne and Murdoch Children’s Research Institute, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Professor Nigel Curtis, Department of Paediatrics, The University of Melbourne, The Royal Children’s Hospital Melbourne, Flemington Road Parkville, VIC 3052; Nigel.Curtis{at}rch.org.au

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Scenario

You are looking after a previously well child recently diagnosed with Kawasaki disease (KD). You start him on intravenous immunoglobulin (IVIG) and are about to start him on aspirin. Knowing the potential adverse effects of aspirin, you wonder whether low-dose aspirin is as effective as high-dose aspirin to prevent coronary artery complications.

Structured clinical question

In a child with KD (patient), is low-dose aspirin (intervention) as effective as high-dose aspirin (control) in reducing the risk of coronary artery complications (outcome) when used with IVIG.

Search strategy and outcome

PubMed and Medline (Ovid, 1946–present) were searched in June 2017 using the following keywords: Kawasaki AND (aspirin OR salicyl* OR ASA) AND (dose OR dosage). Results were limited to those published in English. Case reports and small case series were excluded, as were studies in which patients were not treated with IVIG and those that did not compare different aspirin doses (including a low ‘anti-thrombotic’ dose) within the same study. This identified 333 articles, of which six were relevant (table 1). A hand search of these publications (and those listed …

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