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I would like to add to the article ‘What dose of aspirin should be used in the initial treatment of Kawasaki disease?’ by Luke Guo Yang Ho and Nigel Curtis (Archives, 2017, 102, 1180-1182). Fifteen months have passed since this article concluded that low-dose aspirin is not inferior to higher doses in reducing the risk of coronary artery abnormalities in acute Kawasaki disease. Since then, it is worth considering what and if anything has changed in the field. A recent study not included in the review is a retrospective cohort study by Huang et al1 (2018), where 910 patients followed up for 2 years, which showed that there was no significant difference between 3 groups in terms of anti-inflammation or prevention of coronary artery abnormalities. This paper concluded that the role of aspirin in the treatment of the acute phase of Kawasaki disease should be questioned, as a definite benefit has not been shown. Therefore, in concordance with the conclusion of the review, this rapid response poses that current data remains unchanged with regards to the role and effects of administration of higher doses of aspirin on coronary outcome in acute Kawasaki disease. In the absence of evidence to support higher doses in prevention of coronary artery abnormalities, low-dose aspirin (3–5 mg/kg) may be the safest, most rational approach until better evidence becomes available.
There are currently three prospective randomised control trials in process to continue this inv...
There are currently three prospective randomised control trials in process to continue this investigation2-4, it would be interesting to review this on their completion.
1. Huang, X. et al. Is aspirin necessary in the acute phase of Kawasaki disease? J. Paediatr. Child Health 54, 661–664 (2018).
2. NCT02951234. A Multi-center, Randomized to Compare the Efficacy of IVIG Alone and IVIG Plus High-dose Aspirin in Kawasaki Disease. Https://clinicaltrials.gov/show/nct02951234 doi:10.1002/CENTRAL/CN-01559692
3. NCT02359643. Multi-center Prospective Randomized Control Trail of High Dose Aspirin in Acute Stage of Kawasaki Disease. Https://clinicaltrials.gov/show/nct02359643 (2015). doi:10.1002/CENTRAL/CN-01582768
4. Kuo, H.-C., Guo, M. M.-H., Lo, M.-H., Hsieh, K.-S. & Huang, Y.-H. Effectiveness of intravenous immunoglobulin alone and intravenous immunoglobulin combined with high-dose aspirin in the acute stage of Kawasaki disease: study protocol for a randomized controlled trial. BMC Pediatr. 18, 200 (2018).
Hayley Pillai Johnson (Medical Student, Cambridge University, Cambridge)