Warfarin and aspirin combination therapy for giant coronary artery aneurysm secondary to Kawasaki disease / 中华实用儿科临床杂志

ABSTRACT

Objective To explore whether the warfarin and aspirin combination therapy can prevent cardiovascular events in patients with giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD).Methods Children who had been diagnosed as GCAA secondary to KD in Beijing Children's Hospital Affiliated to Capital Medical University between Jan.1998 and Aug.2012 were enrolled in this study.They were divided into the warfarin plus aspirin group (combination group) and aspirin group.The combination group used the therapy of warfarin and small dose aspirin in the long-term anticoagulation treatment,while the aspirin group used small dosage of aspirin without warfarin.Both groups were followed at the time points of 2nd week,1st month,3rd month,6th month,and 1st year after discharge of the acute stage.Then these children were followed every 6 months.Data on each followed-up included clinical manifestations,coronary artery aneurysm recovery situation and complications.Results (1) The onset age of GCAA caused by KD ranged from 3 months to 13 years and 3 months.Infants who were ≤ 1 year old and children who were ≥5 years old were more susceptible to this disease,their proportion were both 23.1％ . (2) The distribution of GCAA in both groups were similar.GCAA most commonly occurred in the right coronary artery,then the left anterior descending coronary artery,and then the main trunk of left coronary artery,the left circumflex artery was rarely affected.(3) Coronary artery aneurysm in 17 cases(53.1％) retracted in the warfarin combined with aspirin group,while 5 cases(41.7％) in the aspirin group.Fifteen cases(46.9％) in the combination group hadn't obvious change,while the aspirin group got 7 cases (58.3 ％).(4) During the follow-up,2 children (6.3 ％) complicated with intracoronary thromboses in the combination group,while 3 cases(25.0％) in the aspirin group.One case(3.1％) in the combination group suffered myocardial infarction,while 3 cases (25.0％) in the asprin group.Two cases (16.7 ％) in the aspirin group died,while none in the combination group.Coronary artery stenosis occurred in 2 cases (16.7％) in the aspirin group,while 1 case (3.1％) in the combination group.One child had coronary artery occlusion in the aspirin group,while none in the combination group.(5)The combination group had 1 case of serious bleeding event,subarachnoid hemorrhage.In addition,there were 8 cases of nasal bleeding,a total of 19 person-time.There was no serious bleeding event in the aspirin group,only 3 person-time small mount of nasal bleeding.Conclusions Althought warfarin plus aspirin therapy for the long-term anticoagulation treatment in GCAA caused by KD can not affect the retraction of GCAA,it may decrease the incidence of thrombosis,myocardial infarction and mortality.Bleeding complication is more common during the application of wafarin.Therefore the dose of warfarin should be tailored in various children according to the clinical situation,and bleeding complication should be monitored.