Clinical study of Warfarin combined with Aspirin in the treatment of Kawasaki disease complicated with multiple medium and giant coronary artery aneurysms / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the safety and efficacy of Warfarin combined with Aspirin in the treatment of multiple medium and giant coronary artery aneurysms in Kawasaki disease(KD).Methods Clinical and followup data of 45 children diagnosed with KD complicated with multiple medium-sized and giant coronary artery aneurysms from April 2014 to December 2018 at Guangzhou Women and Children's Medical Center were collected.These children were divided into 2 groups.A total of 31 cases received regular oral Warfarin combined with Aspirin called experimental group.There were 14 patients treated with oral Aspirin and Clopidogrel called control group.General information,laboratory examination,electrocardiogram,echocardiography,outcome and bleeding complications of the 2 groups were analyzed retrospectively.Results (1) In experimental group,there were 22 patients found thrombosis under echocardiography.The 10 patients' thrombosis disappeared,5 patients' thrombosis reduced,and 2 patients' increased after treatment.In control group,there were 5 cases found thrombosis.The 2 cases' thrombosis reduced and 3 cases' thrombosis increased.The number of thrombosis in experimental group was significantly reduced,and the number of new thrombosis was less than that in control group (x2 =6.454,P ＜ 0.05).(2) The number of coronary artery aneurysms in experimental group increased slowly than that in control group [12.90％ (4/31 cases) vs.14.28％ (2/14 cases)].(3) The number of coronary artery aneurysms in experimental group decreased rapidly than that in control group [23.91％ (11/46 cases)vs.10.00％ (1/10 cases)].(4) The number of cases of tumor retraction in experimental group was more than that in control group [74.19％ (23/31 cases)vs.42.85％ (6/14 cases)].(5) During the followed-up,there was no abnormality in the blood phosphokinase isozyme and troponin,no abnormality in the electrocardiogram and echocardiogram,no ventricular enlargement and abnormal ventricular wall movement,and the ejection fraction value was within the normal range.No active bleeding and no death occurred in the two groups.Conclusions Warfarin combined with Aspirin is very safe and effective in the treatment of KD coronary tumor,it can reduce thrombosis effectively.Compared with oral Aspirin and Clopidogrel,Warfarin combined with Aspirin can reduce the number of multiple medium sized and large coronary artery aneurysms and reduce the diameter of coronary artery aneurysms.