Fibrinolytic response to venous occlusion is decreased in patients after Kawasaki disease

Albisetti, Manuela; Chan, Anthony; McCrindle, Brian W.; Wong, Derek; Vegh, Patsy; Adams, Margaret; Dinyari, Maria; Monagle, Paul; Andrew, Maureen

doi:10.1097/00001721-200302000-00010

Cited by 19 publications

(9 citation statements)

References 25 publications

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Section: Thromboprophylaxismentioning

confidence: 99%

“…The degree to which both local and systemic endothelial dysfunction and inflammation contribute to thrombosis risk is not completely known. Albisetti et al 365 showed that patients with aneurysms had a decreased fibrinolytic response to venous occlusion as a marker of systemic endothelial dysfunction.Prevention of thrombosis is therefore an important component of long-term management. Given that arterial thrombi are believed to initiate with platelet activation, antiplatelet therapy is the mainstay of initial therapy.…”

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confidence: 99%

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Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,876

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Thromboprophylaxismentioning

confidence: 99%

mentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,876

4,124

View full text Add to dashboard Cite

show abstract

“…With careful clinical follow-up 10 to 20 years after the onset of Kawasaki disease, patients with no coronary artery changes on echocardiography at any stage of the illness seem to demonstrate a risk for clinical cardiac events that is similar to that in the population without Kawasaki disease, 2 but research studies suggest subclinical abnormalities of endothelial function and myocardial flow reserve. 103,[231][232][233] Furthermore, patients with Kawasaki disease seem to have a more adverse cardiovascular risk profile, with higher blood pressure and greater adiposity, as compared with control children. 234 The risk level for a given patient with coronary artery involvement may change over time because of the changes in coronary artery morphology.…”

Section: Risk Stratificationmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,614

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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“…Flow-mediated dilation (an endothelial-dependent response) was reduced in KS patients compared with control subjects many years after the illness, even in patients without detectable early coronary artery involvement. In a long-term case control study, Albisetti et al showed that KS patients were more likely to have impairment of the fibrinolytic system, another marker of endothelial dysfunction, and this again was unrelated to the degree of coronary artery involvement [98]. Pilla et al demonstrated reduced arterial distensibility (an independent risk factor for cardiovascular morbidity and mortality in adults), as assessed using ultrasound pulse wave velocity in the brachio-radial arterial segments of 43 children who had KD a median of 3 years previously [99]; this finding has been recently confirmed by Cheung et al [100] and also documented in children with PAN [101].…”

Section: Does Vasculitis In the Young Predispose To Premature Atherosmentioning

confidence: 99%

What’s new in the aetiopathogenesis of vasculitis?

Brogan¹

2007

Pediatr Nephrol

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The cause of the majority of childhood vasculitides is unknown although it is likely that a complex interaction between environmental factors and inherited host responses trigger the disease and determine the vasculitis phenotype. Epidemiological clues continue to implicate infectious triggers in Kawasaki syndrome (KS) and Henoch Schonlein purpura (HSP). Several genetic polymorphisms have now been described in KS and HSP which predispose to disease or predict disease severity. Anti-neutrophil cytoplasmic antibodies (ANCA) are now known to be directly involved in the pathogenesis of vascular injury in ANCA-associated vasculitides, although why some individuals develop ANCA in the first instance is not yet understood. Endothelial injury and repair are active areas of research in vasculitis. It is now possible to track endothelial injury non-invasively in children with vasculitis using surrogate markers of endothelial injury. The vasculogenic pathways involved in vascular repair following vasculitis, including endothelial progenitor cells, are beginning to be studied. It is anticipated that an improved understanding of the aetiopathogenesis of vasculitis in the young will ultimately shape future novel diagnostic and therapeutic approaches and will help us predict which children may develop premature arteriosclerosis in later life.

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Fibrinolytic response to venous occlusion is decreased in patients after Kawasaki disease

Cited by 19 publications

References 25 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

What’s new in the aetiopathogenesis of vasculitis?

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