Thrombosis in Kawasaki Disease: Implications for Coronary Artery Aneurysm Risk, Diagnosis, and Anti-Thrombotic Management

Kawasaki disease (KD) is an acute systemic vasculitis that largely affects East Asian children, and these patients are at high risk for coronary artery aneurysms (CAAs), which predispose them to thrombotic events. Although the cause of KD remains unknown, the pathogenesis of thrombotic complications in KD appears to be complex and multifaceted, involving interactions between endothelial cell (EC) dysfunction, platelet activation, and immune cell interactions. In addition, KD can affect not only the coronary arteries but also the systemic vasculature, which can lead to thrombotic events beyond the coronary arteries. Early diagnosis and management of KD are essential to mitigate these risks, and new biomarkers, such as platelet function and leukocyte-platelet aggregates (LPAs), hemodynamics, are showing promise in identifying patients at high risk for thrombosis. In this review, we will explore the pathophysiologic mechanisms that contribute to thrombus formation in KD, review diagnostic strategies and emerging biomarkers, and discuss therapeutic options to prevent and manage KD-related thrombosis. A better understanding of these mechanisms may lead to improved approaches for early detection, risk assessment, and targeted therapy to decrease thrombotic complications in KD.