Safety and Efficacy of Warfarin plus Aspirin Combination Therapy for Giant Coronary Artery Aneurysm Secondary to Kawasaki Disease: A Meta-Analysis

Abstract

Objective: To compare the safety and efficacy of warfarin plus aspirin versus aspirin alone for the treatment of children with giant coronary artery aneurysm (CAA) secondary to Kawasaki disease (KD). Methods: We searched the PubMed, EMBASE, Cochrane Library, CNKI, WANFAN and VIP databases. We selected case-controlled trials of warfarin plus aspirin versus aspirin alone for the treatment of children with giant CAA secondary to KD. Results: Six retrospective studies met our inclusion criteria. There was no significant difference between the warfarin plus aspirin and aspirin alone groups in the rate of CAA regression (OR 1.38, 95% CI 0.52-3.68, p = 0.52) or the incidence of persistent CAA (OR 2.34, 95% CI 0.16-33.50, p = 0.53), coronary artery stenosis (OR 0.55, 95% CI 0.18-1.72, p = 0.30) or thrombus formation (OR 0.50, 95% CI 0.15-1.69, p = 0.26). There was evidence that warfarin plus aspirin reduced the incidence of coronary artery occlusion (OR 0.08, 95% CI 0.02-0.29, p < 0.0001), cardiac infarction (OR 0.27, 95% CI 0.11-0.63, p = 0.003) and death (OR 0.18, 95% CI 0.04-0.88, p = 0.03). Conclusion: Warfarin plus aspirin therapy reduced the incidence of occlusion, cardiac infarction and death in children with giant CAA secondary to KD.

Kawasaki Disease: Issues in Diagnosis and Treatment - A Developing Country Perspective

“…Children with KD can have significant long-term morbidity and this can manifest in young adulthood as coronary ischemia, myocardial infarction and sudden death [31]. In a recent publication from Egypt, Rizk et al have reported that 6.7 % of adults less than 40 y of age who had possible myocardial ischemia had angiographic lesions which suggested antecedent KD [32].…”

Kawasaki disease: Medical therapies

“…For small infants, similar physiology may occur at smaller dimensions, prompting some to consider a z score criterion of ≥10 for treatment with anticoagulants. A recent meta‐analysis of 6 retrospective studies included 159 patients treated with warfarin and aspirin, and 158 treated with aspirin alone . Compared to patients treated with aspirin alone, those receiving warfarin and aspirin together had a significantly lower odds of mortality (OR 0.18 ( P = .03), coronary artery occlusion (OR 0.08 ( P = .001), and myocardial infarction (OR 0.27, P = .003).…”

“…Of note, the mechanism of coronary thrombosis in different in children with Kawasaki disease than in older patients with atherosclerotic coronary artery disease, in whom acute plaque rupture precipitates myocardial infarction. The goals of therapy, however, are similar in children and adults with coronary thrombosis, namely to reestablish coronary patency, salvage myocardium, and improve survival …”

Comment on the Paper by Su et al. Entitled ‘Safety and Efficacy of Warfarin plus Aspirin Combination Therapy for Giant Coronary Artery Aneurysm Secondary to Kawasaki Disease: A Meta-Analysis'

“…I read with great interest the study by Su et al [1 ]in which they conducted a meta-analysis of retrospective studies comparing treatment with aspirin alone to treatment with aspirin and warfarin in patients with giant coronary artery aneurysms (CAAs) secondary to Kawasaki disease (KD). Current guidelines for the management of KD patients with giant CAAs suggest that the combination of aspirin and warfarin is beneficial in this patient population, although data supporting this are relatively scarce and come from retrospective studies with small cohorts of patients [2].…”