Breaking News
February 19, 2018 - Study sheds light on biology that guides behavior across different stages of life
February 19, 2018 - Morning Break: Transgender Breast Feeding; Brazilian ‘Pro-Vaxxers’; Post-Stroke Exercise
February 19, 2018 - Meningitis vaccination strategy in Africa found to be effective, economical
February 19, 2018 - Researchers uncover how excess calcium may influence development of Parkinson’s disease
February 19, 2018 - Psoriasis drug also effective at reducing aortic inflammation
February 19, 2018 - Excess emissions can make serious contributions to air pollution, study shows
February 19, 2018 - Diabetes Drugs Differ on HF; School-Based Obesity Program Flop; Plaque Type in ACS
February 19, 2018 - Surgical infections linked to drug-resistant bugs, study suggests
February 19, 2018 - Poor awareness may hinder a child’s early dental care
February 19, 2018 - FDA Approves Apalutamide (Erleada) to Help Curb a Tough-to-Treat Prostate Cancer
February 19, 2018 - Educational Tool Boosts Cervical Length Screening
February 19, 2018 - Spider’s web inspires removable implant that may control type 1 diabetes
February 19, 2018 - Scientists develop fluorescent probe to identify cancer stem cells
February 19, 2018 - University Hospital of Santiago de Compostela participates in large pancreatic cancer study
February 19, 2018 - New blood test shows promise to revolutionize diagnosis of tick-borne diseases
February 19, 2018 - Report: Use, Not Price, Drives State Health Costs
February 19, 2018 - Emergency services crews often unprepared for diabetic crises
February 19, 2018 - Scientists in Sweden create DNA nanowires that offer hope for treatment of diseases
February 19, 2018 - ID Break: Clean Hands, Fewer Abx; $11 Million HIV Cure?; MenB Vax for Kids
February 19, 2018 - Patient exposure to X-rays depends on how dentists are paid
February 19, 2018 - Study reveals parents’ views toward children’s tanning bed use
February 19, 2018 - Shot may help reduce risk of shingles
February 19, 2018 - FDA approves first treatment to reduce risk of NSCLC progression
February 19, 2018 - FDA Expands Approval of Imfinzi (durvalumab) to Reduce the Risk of Non-Small Cell Lung Cancer Progressing
February 19, 2018 - D.C. Week: Congress Passes Spending Bill
February 19, 2018 - Heart-muscle patches made with human cells improve heart attack recovery
February 19, 2018 - FDA Approves First Blood Test to Detect Concussions
February 19, 2018 - Survival Bump in Bladder Cancer with Keytruda
February 18, 2018 - Scientists describe the mechanism of heart regeneration in the zebrafish
February 18, 2018 - Scientists uncover the structure of microtubule motor proteins
February 18, 2018 - Light-activated cancer drugs without toxic side effects are closer to becoming reality
February 18, 2018 - Pioneering research could provide novel insight into how genomic information is read
February 18, 2018 - Pearls From: David Putrino, PhD
February 18, 2018 - Researchers uncover how cancer stem cells drive triple-negative breast cancer
February 18, 2018 - Morning Break: Anti-Anti-Vaxxers; Private Piercings Prohibited; A Case for Pelvic Massage
February 18, 2018 - Lower-dose radiation effective, safe for HPV+ head and neck cancer after induction chemo
February 18, 2018 - Specialist residential service for adults with autism opens in Swansea
February 18, 2018 - FDA Moves to Limit Loperamide Doses per Package
February 18, 2018 - Alcohol use disorder – Genetics Home Reference
February 18, 2018 - Autism might be better detected using new two-minute questionnaire
February 18, 2018 - Hand hygiene-intervention practices may reduce risk of infection among nursing home patients
February 18, 2018 - Researchers develop most sophisticated mini-livers to date
February 18, 2018 - Obamacare Helped More Young Women Get Prenatal Care: Study
February 18, 2018 - School-Based Program Fails to Dent Kids’ Obesity
February 18, 2018 - Research compares neural activity in children with and without autism spectrum disorder
February 18, 2018 - Poor fitness levels increase the risk dementia, concludes study
February 18, 2018 - Risk Score May Reveal if Kids are Victims of Ill-Treatment
February 18, 2018 - Adding Folic Acid to Corn Masa Flour May Prevent Birth Defects
February 18, 2018 - Acute treatment suppresses posttraumatic arthritis in ankle injury
February 18, 2018 - A Role for Budesonide in Autoimmune Hepatitis?
February 18, 2018 - Lupus patients exhibit altered cell proteins, a discovery with potential implications for diagnostics
February 18, 2018 - Muscle plays vital role in regulating heat loss from the hands
February 18, 2018 - High-tech brain scans can provide new way to define intelligence
February 18, 2018 - Study reveals the association between ultra-processed foods and cancer
February 18, 2018 - Prescription Opioid Use Tied to Higher Pneumonia Risk
February 18, 2018 - A non-invasive method to detect Alzheimer’s disease
February 18, 2018 - Deletion of specific enzyme leads to improvement in memory and cognitive functions
February 18, 2018 - Amyloid protein may be transmitted through neurosurgical instruments, study suggests
February 18, 2018 - Electric brain signals of males and females show differences
February 18, 2018 - American Heart Association commends McDonald’s for offering healthier menu in kids’ meals
February 18, 2018 - Parents Find Kids’ Weight Report Cards Hard to Swallow
February 18, 2018 - Does a Financial Conflict of Interest Ever Expire?
February 18, 2018 - Exercise can improve Alzheimer’s symptoms
February 18, 2018 - Scientists develop green chemistry method to improve pharmaceutical manufacturing efficiency
February 17, 2018 - ‘A Time Clock to a Tissue Clock’ for Acute Stroke Care
February 17, 2018 - Cancer Care Gets Personal | NIH News in Health
February 17, 2018 - Do more youth use or do youth use more?
February 17, 2018 - Eating faster linked to obesity
February 17, 2018 - Who’s Still Smoking? ACS Report Highlights Most Vulnerable Adults
February 17, 2018 - Study of smoking and genetics illuminates complexities of blood pressure
February 17, 2018 - Study reveals new link between bone cells and blood glucose level
February 17, 2018 - Children with reading challenges may have lower than expected binocular vision test results
February 17, 2018 - Mass Shootings Trigger Change for Emergency Medicine
February 17, 2018 - ECMO helps revive woman thought to be drowned
February 17, 2018 - Learning stress-reducing techniques may benefit people with epilepsy
February 17, 2018 - Shedding Pounds Before Weight-Loss Surgery a Smart Move
February 17, 2018 - FDA Approves New Cystic Fibrosis Drug Combo
February 17, 2018 - Augmented Reality helps surgeons to ‘see through’ tissue and reconnect blood vessels
February 17, 2018 - Emotional state affects operation of the entire brain instead of being restricted to specific regions
February 17, 2018 - Apalutamide Slows Metastasis in Prostate Cancer
High-Dose Aspirin Preferred for Kawasaki’s

High-Dose Aspirin Preferred for Kawasaki’s

image_pdfDownload PDFimage_print

Action Points

  • Note that this observational study leveraged the differing treatment practices at two hospitals to determine that high-dose aspirin may reduce dependence on IVIG for treatment of Kawasaki disease in children.
  • Be aware that this was not a randomized trial; other treatment practices that differ between the two study hospitals may have influenced the results.

The use of low-dose aspirin in conjunction with a single dose of intravenous immunoglobulin (IVIG) among children with Kawasaki disease was associated with three times the risk of requiring a second IVIG dose compared with high-dose aspirin, a retrospective chart review in two Canadian centers concluded.

In one hospital where low-dose acetylsalicylic acid (ASA; 3 to 5 mg/kg/day) was routinely used, 23% of patients were given a second infusion of IVIG, compared with 8.7% of those treated in another hospital where high-dose ASA (80 to 100 mg/kg/day) was used (P=0.003), according to Anita Dhanrajani, MBBS, of British Columbia Children’s Hospital in Vancouver, and colleagues.

In a multivariable analysis that adjusted for potential confounders including platelet count, age, and C-reactive protein (CRP), the odds ratio for a second IVIG dose with low-dose ASA was 3.2 (95% CI 1.1-9.1, P=0.03), the researchers reported online in Arthritis Care & Research.

Kawasaki disease is an acute vasculitis predominantly affecting children younger than age 5 years, and currently is the most common form of acquired heart disease in developed countries, especially among those of Asian ancestry. The disease is associated with potentially severe cardiac outcomes, particularly the development of coronary artery aneurysms.

The American Heart Association (AHA) first published recommendations for diagnosis and treatment of Kawasaki disease in 1993; these have been revised, most recently in 2017. The recommendations, which favor high-dose aspirin, have been developed to assist clinicians in decision-making regarding treatment with IVIG, ASA, and corticosteroids, but have not been uniformly adopted. While an IVIG dosage of 2 g/kg is standard, the aspirin dose has been varied, with high doses possibly having greater anti-inflammatory effects but low doses being assumed to have better gastrointestinal tolerability.

In addition, IVIG can be costly and should be judiciously used, according to Dhanrajani’s group.

The standard approach used at British Columbia Children’s Hospital (center 1) involves a single IVIG infusion plus aspirin, 3 to 5 mg/kg/day, for 6 weeks, while at Stollery Children’s Hospital in Edmonton (center 2), the aspirin dose is 80 to 100 mg/kg/day until 24 to 48 hours after defervescence.

Some 10% to 20% of children with Kawasaki disease fail to respond to the initial IVIG dose, which is referred to as IVIG resistance. These patients usually are given a second dose, but are at increased risk of coronary complications and may have longer hospital stays and adverse events such as hemolytic anemia.

Therefore, to see if IVIG resistance is influenced by ASA dose, the researchers reviewed 122 charts from the years 2009 to 2014 at center 1 and from 127 at center 2 from 2005 to 2014.

At baseline, patient ages ranged from 33 to 36 months, and almost two-thirds were boys. Asians were significantly more common in center 1 (53.3% versus 13.4%, P<0.001).

The brand of IVIG most often used in center 1 was Gamunex, and a local formulation of 10% IVIG was the most common in center 2.

To determine whether the different time frames in the two centers influenced the results, the researchers conducted a secondary analysis that included patients only seen from 2009 to 2014, finding an incidence of IVIG resistance of 23% in center 1 and 7.3% in center 2.

Among patients requiring a second infusion of IVIG, time between infusions ranged from 25 to 66 hours.

In the main multivariate analysis, ethnicity was not included, because it was assigned based on family name, which can be unreliable because of marriage and mixed ethnicity. However, when Asian ethnicity was added to the analysis, 19.5% of Asian children had IVIG resistance compared with 13.8% of non-Asians, which was not a significant difference, and the odds ratio for low-dose ASA and IVIG resistance was 3.7 (95% CI 1.2-11.6, P=0.02).

The mean hospital stay was 4.1 days in center 1 and 4.7 in center 2. “It is surprising that despite the difference in IVIG resistance, we could not document a difference in length of hospital stay between the two centers. This may be due to differences between the centers in usual practices regarding discharge of patients with Kawasaki disease,” the researchers noted.

Coronary artery aneurysms developed in two patients from center 1 and in six patients from center 2, which was not significantly different. The study was not powered to detect a difference in this outcome, however.

The three times increased odds of a second IVIG dose seen with low-dose ASA represented a 14% absolute increase, and the number needed to treat was seven.

“Until there is better evidence from randomized controlled trials, it seems reasonable to adhere to AHA guidelines and prescribe high-dose ASA in the initial phase of Kawasaki disease,” Dhanrajani’s group concluded.

Among the limitations of the study were its retrospective design and a lack of information about adverse events associated with ASA.

Dhanrajani and co-authors disclosed no relevant relationships with industry.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2018-04-01T00:00:00-0400

last updated

Tagged with:

About author

Related Articles