Introduction This study sought to assess whether warfarin and aspirin combination therapy can prevent cardiovascular events in children with giant coronary artery aneurysm (CAA) caused by Kawasaki disease.

Method Children with giant CAA secondary to Kawasaki disease in our hospital were included. They were randomly divided into warfarin group (warfarin + aspirin) and control group (aspirin only). The dose of warfarin was adjusted by INR (1.5–2.0). Follow-up time included 2nd week, 1st month, 3rd month, 6th month and every 6 months afterward. Clinical data and complications were recorded.

Result Sixty-five children were included with age of 3 months to 13 years. CAA most commonly occurs in right coronary artery, then left anterior descending, and main trunk. Left circumflex artery is rarely affected. CAA in 17 cases (53.1%) retracted in warfarin group, 5(41.7%)in controls. During follow-up, 2 children (6.3%) presented with intracoronary thromboses in warfarin group, 3 (25%) in controls. One case in warfarin group suffered myocardial infarction, 3 (25%) in control. Two children in control group died, while none in warfarin group. Coronary artery stenosis occurred in 2 children (16.7%) in controls, while one in warfarin group. Bleeding event occurred in 9 children including 1 with subarachnoid haemorrhage in warfarin group while only in 3 in the controls.

Conclusion Warfarin therapy could decrease the risk of thrombosis, myocardial infarction and mortality. Minor bleeding event is common and need to be monitored.