Direct oral anticoagulants in children with giant coronary artery aneurysms from Kawasaki disease: a systematic review and meta-analysis

Background: To evaluate the comparative efficacy and safety profile of direct oral anticoagulants (DOACs) vs. conventional anticoagulation in children with Kawasaki disease (KD)-associated Giant coronary artery aneurysms (GCAAs). Methods: Databases searched included PubMed (MEDLINE), Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov from conception until October 2025. Studies that (1) enrolled patients younger than 19 years with documented KD-associated GCAAs; (2) administered DOACs; (3) reported at least one efficacy/safety outcome, were included. Efficacy outcomes included thromboembolic events (coronary thrombosis, myocardial infarction, systemic thromboembolism). Safety outcomes included major or Clinically Relevant Non-Major (CRNM) bleeding. A random-effects model was used to estimate the pooled effects. Results: = 0.13]. Conclusion: DOACs have potentially non-inferior efficacy and safety profiles compared to conventional agents, supporting the use of DOACs as a first-line anticoagulation strategy in one of childhood's most serious cardiovascular conditions. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251004094, PROSPERO CRD420251004094.