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Low-dose or no aspirin administration in acute-phase Kawasaki disease: a meta-analysis and systematic review
  1. Ming-Hsiu Chiang1,
  2. Hsingjin Eugene Liu2,
  3. Jinn-Li Wang3,4
  1. 1School of Medicine, Faculty of Medicine, Taipei Medical University, Taipei, Taiwan
  2. 2Graduate Institute of Clinical Medicine, Collage of Medicine, Taipei Medical University, Taipei, Taiwan
  3. 3Division of Hematology Oncology, Department of Pediatrics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  4. 4Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Jinn-Li Wang, Pediatrics, Wan Fang Hospital, No.111, Sec3, Xinglong Rd, Wenshan Dist, Taipei city 116, Taiwan; jlwang{at}


Objective To compare the efficacy of low-dose or no aspirin with conventional high-dose aspirin for the initial treatment in the acute-phase of Kawasaki disease (KD).

Design A meta-analysis and systematic review of randomised control trials and cohort studies.

Methods All available articles that compared different dosage of aspirin in the acute-phase of KD published until 20 September 2019 were included from the databases of PubMed, Embase and Cochrane Central Register of Controlled Trials Central without language restrictions. Extracted data from eligible studies were reviewed by two authors independently and analysed by using RStudio software.

Results Nine cohorts with a total of 12 182 children were enrolled. We found that low-dose (3–5 mg/kg/day) or no aspirin in the acute-phase KD was associated with reducing the risk of coronary artery lesions (CALs, OR=0.81, 95% CI 0.69 to 0.95). No differences were observed in intravenous immunoglobulin resistance, length of hospital stay and fever days after admission (OR=1.35, 95% CI 0.91 to 1.98; standard mean difference (SMD)=0.17, 95% CI −1.07 to 1.4; SMD=0.3, 95% CI −1.51 to 2.11) in the low-dose/no aspirin subgroup compared with the high-dose (≥30 mg/kg/day) aspirin subgroup. We did not identify any potential factors affecting the homogeneity of CAL risk as well as clinical important effects in all included studies.

Conclusions Prescribing low-dose or no aspirin in the acute-phase of KD might be associated with a decreased incidence of CAL. However, additional well-designed prospective trials are required to support the theory.

  • cardiology
  • outcomes research
  • vascular disease

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  • Contributors MHC and JLW designed the study. The two authors conducted the searches and data extraction independently. MHC conducted the statistical analysis and JLW contributed to data interpretation as well as manuscript revision. HEL revised the final data interpretation. All authors had full access to all the data collected in this meta-analysis, checked for accuracy and approved the final version of this article.

  • Funding This study was supported by a grant from Wan Fang Hospital (grant number 105-wf-eva-18). This article was edited by Wallace Academic Editing.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing is not applicable as no datasets were generated and/or analysed for this study.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.