What dose of aspirin should be used in the initial treatment of Kawasaki disease?
| Citation | Study group | Study type | Outcomes | Key results | Comments |
| Dallaire et al
1 (2017) | Canada 1213 children with KD (2004–2015) | Retrospective cohort | Prevalence of CAA (z score≥2.5), duration of fever |
All treated with IVIG (single dose 2 g/kg) Paracetamol use not reported High-dose ASA (80 mg/kg/day) (n=848) vs low-dose ASA (3–5 mg/kg/day) (n=365) New CAA: 20.5% vs 22.2%, adjusted risk difference: 0.3% (95% CI −4.5% to 5.0%) Persistent CAA (>6 weeks): 13.2% vs 12.3%, adjusted risk difference: −1.9% (−5.3% to 1.5%) Duration of fever: 7.8±3.8 days vs 7.9±2.6 days, adjusted risk difference: 0.18 days (−0.2 to 0.61 days) Follow-up: 12 months | Study concludes no difference in reduction of risk of CAA between high-dose and low-dose ASA Large study Aspirin dose based on centre guidelines and not severity of disease Variation in rescue therapy (second dose of IVIG, steroid and monoclonal antibody use, and so on) |
| Kim et al
2 (2017) | Korea 8456 children with KD | Retrospective cohort | Prevalence of CAA (z score≥2.5 and Japanese criteria) |
All treated with IVIG (single dose 2 g/kg) Paracetamol use not reported Medium/high-dose ASA (≥30 mg/kg/day) (n=7947) vs low-dose ASA (3–5 mg/kg/day) n=509 z-score: 24.8% vs 18.3% (p=0.001) Japanese criteria: 19.0% vs 10.4% (p<0.001) Follow-up: 3 months | Study concludes that medium/high dose of ASA not protective against CAA Worse outcomes with high-dose ASA Not randomised, therefore more severe cases may have been given higher dose of ASA Unbalanced number of subjects |
| Amarilyo et al 3 (2017) | Israel 358 children with KD (2003–2014) | Retrospective cohort | Prevalence of CAA, length of hospital stay, fever ≥72 hours |
All treated with IVIG (single dose 2 g/kg) Paracetamol use not reported High-dose ASA (80–100 mg/kg/day) (n=315) vs low-dose ASA (3–5 mg/kg/day) (n=43) New CAA: 10.2% (20/196) vs 4.2% (1/24) (p=0.34) New CA ectasia: 24.5% (48/196) vs 4.2% (1/24) (p=0.024) Equivalence tests: risk difference unlikely >3.5% Hospital stay: 7.3±4.6 days vs 5.7±2.8 days (p=0.03) Fever ≥72 hours: 9.3% vs 7% (p=0.62) Follow-up: not reported | Study concludes no difference in clinical outcome between high-dose and low-dose ASA Aspirin dose based on specific centre guidelines and not severity of disease Unbalanced number of subjects |
| Kuo et al
4 (2015) | Taiwan 851 children with KD (1999–2009) | Retrospective cohort | Prevalence of CAA, length of hospital stay, resolution of fever (<48 hours) |
All treated with IVIG (dose not reported) Paracetamol use not reported Medium/high-dose ASA (>30 mg/kg/day) (n=305) vs no ASA (n=546) New CAA: 52/302 (17.2%) vs 84/546 (15.3%) (p=0.67) Length of hospital stay: 6.3±0.2 days vs 6.7±0.2 days (p=0.13) No resolution of fever: 10.2% vs 7.0% (n=38) (p=0.07) Follow-up: not reported | Study concludes no benefit of high-dose ASA on CAA formation or resolution of fever Lower Hb and impaired decrease in CRP and hepcidin in high-dose ASA group noted |
| Rahbarimanesh et al
5 (2014) | Iran 69 children with KD | Observational | Prevalence of CAA, duration of fever, length of hospital stay |
All treated with IVIG (single dose 2 g/kg) Paracetamol use not reported High-dose ASA (80–100 mg/kg/day) (n=27) vs low dose ASA (3–5 mg/kg/day) (n=42) New CAA: 4% vs 5.3% (p=1.000) Duration of fever: 41.96±19.63 hours vs 46.00±50.49 hours (p=0.694) Length of hospital stay: 6.0±1.3 days vs 6.36±2.80 days (p=0.540) Follow-up: 8–10 weeks | Study concludes that high-dose ASA has no advantage over low-dose. Small study Patients allocated to low-dose aspirin group only if no coronary artery aneurysm observed |
| Saulsbury6 (2002) | USA 72 children with KD (1987–2000) | Retrospective cohort | Prevalence of CAA, duration of fever |
Treated with IVIG; 400 mg/kg for 4 days (n=21) or single dose 2 g/kg (n=51) Paracetamol use not reported High-dose ASA (80–100 mg/kg/day) (n=23) vs low-dose ASA (3–5 mg/kg/day) (n=46) Prevalence of CAA: 17%; all identified pretreatment No new CAA Duration of fever: 47±8 hours vs 34±5 hours (p=0.13) Follow-up: up to 8 weeks | Study concludes no difference in fever duration with different doses of ASA. Differing IVIG doses not accounted for in results |
ASA, aspirin; CAA, coronary artery aneurysms; IVIG, intravenous immunoglobulin; KD, Kawasaki disease.