Efficacy of halfdose aspirin in Kawasaki disease: Insights from a single center experience

BackgroundLong-term oral aspirin (Asp) therapy poses challenges in children with Kawasaki Disease (KD) complicated by coronary artery aneurysms (CAA), especially when frequent epistaxis is present.ObjectiveThis study seeks to evaluate the efficacy and safety of a reduced-dose aspirin regimen for an antiplatelet therapy during the subacute and convalescent phases of KD.MethodsThis retrospective study included 554 pediatric KD patients (350 males, 204 females; median age: 2.5 years). The patients were divided into two groups based on their aspirin dosage initiated one week after fever subsidence: The observation group (OG, n = 253) received low-dose Asp (1.5–2.5 mg/kg/day), while the control group (Ctrl, n = 301) received standard-dose Asp (3–5 mg/kg/day).ResultsThe incidence of bleeding was significantly lower in the OG compared to the Ctrl group (p < 0.05). In both groups, the coronary thrombi either shrank or resolved after one year following alteplase therapy, provided that the international normalized ratio (INR) was maintained at 2.0–3.0 and arachidonic acid (AA) inhibition remained below 20%, with no significant intergroup difference (p > 0.05). Aspirin resistance (AR) was observed in 17 OG patients, which resolved after increasing the Asp dose to 3–5 mg/kg/day for one week. Mural thrombosis occurred in six patients (3 per group), none of whom had AR.ConclusionReducing aspirin to a half-dose regimen after intravenous immunoglobulin (IVIG) treatment in the subacute and recovery phases of KD is both safe and effective, thereby significantly lowering the risk of bleeding without compromising the antithrombotic efficacy.